Common Inclusions of Health Insurance

Why Should You Check Inclusions of a Health Insurance Plan Before Buying?

Inclusions in health insurance plans refer to the specific healthcare expenses covered in a medical insurance policy. They comprise of medical treatments, surgical procedures, diagnostic tests, medications, and other medicare services that an insurance company agrees to pay for as per the terms & conditions of the policy.

Checking inclusions before purchasing a mediclaim policy enables you to assess the policy coverage and understand the financial protection offered by your insurer. If you are unaware of your policy inclusions, you might raise a claim for medical expenses that your insurer does not cover. This may lead to the rejection of your claim.

Thus, checking the inclusions allow you to buy a medical insurance policy that meets all your healthcare requirements.

Key Inclusions of Health Insurance in India

Some common inclusions of health insurance in India are as follows-

1. In-patient Hospitalization

   If you are hospitalized for at least 24 hours, it is considered an in-patient hospitalization. Almost all medical insurance plans offer coverage for in-patient hospitalization expenses, including the cost of hospital room, nursing care, Intensive Care Unit (ICU) treatment, medicines & drugs, diagnostic tests, operation theatre charges, doctor's fees, etc.

2. Pre-existing Diseases

   A pre-existing illness is a medical condition that you already have before purchasing a mediclaim policy. Health insurance plans typically cover pre-existing diseases after a waiting period ranging from 2 to 3 years. Make sure to declare your pre-existing conditions at the time of policy purchase to avoid claim rejections in future.

   You may also read - Pre-existing (PED) Cover from Day 1

3. Pre-hospitalization Expenses

   Mediclaim policies also offer coverage for pre-hospitalization expenses or medical expenses incurred before your hospital admission. They may include doctor consultation fees, diagnostic test charges, medicines costs, etc. Pre-hospitalization expenses are usually covered for up to 30, 60, or 90 days.

4. Post-hospitalization Expenses

   Medical expenses that you may incur after getting discharged from the hospital are referred to as post-hospitalization expenses. They include the cost of follow-up consultations, medications, medical tests, physiotherapy, and any necessary treatments during the recovery period. Health insurance plans cover these expenses for up to 60, 90, or 180 days.

   You may also read - Pre & Post Hospitalization Expenses in Health Insurance

5. Day Care Treatments

   Day care treatments refer to those medical procedures that do not require a hospital stay of 24 hours, thanks to advancements in medical technology. Most health plans offer coverage for day care treatments, such as chemotherapy, dialysis, cataract surgery, radiotherapy, piles, etc.

6. Preventive Health Check-ups

   Several medical insurance policies offer coverage for preventive health check-ups. These check-ups typically include evaluations of blood sugar, renal function, ECG, and other basic health parameters. Preventive health check-ups enable you to take timely precautions and prevent the development of any serious medical condition or disease.

   You may also read - Know about Preventive Health Check-ups

7. Maternity Benefit

   Many health insurance plans in India offer coverage for maternity expenses, subject to a waiting period ranging from 3 months to 4 years. It covers pregnancy-related expenses for both normal and cesarean (C-section) deliveries, along with pre & post-natal costs and newborn baby expenses.

   You may also read - Health Insurance with Pregnancy Cover

8. Organ Donor Expenses

   Organ donor expenses cover the cost of harvesting the organ donated for a transplant surgery of the insured. They include the cost of compatibility tests, in-patient hospitalization, pre & post-hospitalization, post-surgery care, and recovery.

9. Mental Health Cover

   In 2020, the Insurance Regulatory and Development Authority of India (IRDAI) mandated all health insurance companies to provide mental illness coverage. As a result, mediclaim plans now cover the treatment cost of mental illnesses, such as bipolar affective disorders, anxiety & stress disorders, acute depression, sleep & eating disorders, dementia, schizophrenia, etc.

   You may also read - Does Health Insurance Cover Psychological Disorders?

10. AYUSH Treatment

    Health insurance policies also cover alternative medicine treatments, collectively known as AYUSH (Ayurveda, Yoga & Naturopathy, Unani, Siddha, and Homeopathy). However, they only cover in-patient alternative treatments taken at a government hospital or institute recognized and/or accredited by the Quality Council of India or the National Accreditation Board.

11. Domiciliary Treatment

    Domiciliary treatment refers to the treatments taken at home in situations where hospitalization is not possible due to the unavailability of hospital beds or specific medical conditions. Your health policy will cover the cost of domiciliary treatment if your attending doctor recommends it.

12. Modern Treatment

    IRDAI mandated the coverage of 12 modern treatments in health insurance plans. Many mediclaim policies in India cover the cost of these advanced treatments, including hospital stays, domiciliary hospitalization, day care procedures, etc. Some of the modern treatments covered by health insurance companies include immunotherapy, intra vitreal injections, stem cell therapy, robotic surgeries, stereotactic radio surgeries, deep brain stimulation, etc.

13. Ambulance Expenses

    Health insurance covers the cost of emergency transportation of the insured patient to a hospital or day care centre. It is a common feature across most health plans, allowing you to access quick medical assistance during emergencies.

14. Consumables Cover

    Consumables cover pays the cost of non-medical items required during treatment or hospitalisation. It includes items like surgical gloves, dressings and syringes, PPE kits, mineral water, tissue paper, etc. Most of these items are meant for single-use and, therefore, might be required multiple times during a hospital stay.

15. Second Medical Opinion

    Some health plans in India extend coverage for a second medical opinion, under which you can consult another specialist for a second diagnosis or perspective. This is especially helpful in the case of critical illnesses like cancer, where you may want confirmation before proceeding with a specific treatment.

You may also read - Common Exclusions of a Health Insurance Plan

Summing It Up!

Understanding the inclusions of a health insurance allows you to understand the coverage provided by your insurance company. Besides, it also prevents your claims from getting rejected. Therefore, make sure to read and comprehend the policy inclusions in detail before you buy medical insurance.