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26 Sep, 2022
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health insurance

What are the Things Covered Under Health Insurance Policy

After the pandemic, if there is one thing we are all concerned about – it is health. Health was always an important factor, but it has taken a greater stand in the last two years with the virus spurging in. More than health concerns, everyone is more concerned about the ‘health costs’ We are bound to be instilled with fear – being sick and paying off the hospital bills, even after recovery from being sick. But how can we be money-cautious when it comes to health, right? 

In an assumption, where I am pretty sure I am right, everyone is aware that only if you are healthy, you can earn more money. Upfront putting it on the table, health > money. But what if there was a better solution? You know what I am about to say. Yes. It is – gets insured. Get your health insured. Let’s take one step at a time while we talk about this.

What Does it Mean to Get your Health Insured?

Health insurance is an arrangement in which an insurance company undertakes to guarantee compensation for medical expenses if the insured becomes ill or is involved in an accident that requires hospitalization. 

In general, insurance firms have agreements with top hospitals to give cashless care to their customers. In the absence of a tie-up with the hospital, the insurance company reimburses the insured’s expenses. The government also encourages health insurance by granting a tax break.

Why Do You Need a Health Insurance?

Purchasing a health insurance policy for yourself and your family is critical because medical care is costly, particularly in the private sector. Hospitalization might drain your bank account and throw your finances off track. It will be even more difficult if the individual who brings in the money is now in the hospital. 

All of this can be avoided by just paying a small annual premium, which will reduce your stress in the event of a medical emergency. A good health insurance coverage will normally cover doctor consultation fees, medical test costs, ambulance charges, hospitalization costs, and even post-hospitalization recovery expenditures to some extent.

Types of Health Insurance Plans 

 – Mediclaim

The most basic sort of health insurance plan is a mediclaim or hospitalization plan. When you are admitted to the hospital, they pay for your treatment. The payment is based on actual hospital expenses submitted in the form of original bills. Most of these policies provide coverage for the entire family up to a specific maximum.

 – Critical Illness Insurance Plans

Specific life-threatening conditions are covered by Critical Illness Insurance Plans. These disorders may necessitate lengthy therapy or even a change in lifestyle. Unlike hospitalization plans, the reimbursement is based on the Critical Illness cover purchased by the consumer rather than actual hospital charges. The coverage allows you to spend the money to change your lifestyle or buy new medications. It also serves as a source of income during the period you are unable to return to work due to illness. The payout under these policies is based on the disease’s diagnosis, and the original medical bills are not necessary.

What Does a Health Insurance Cover?

Well, most of the time, it will depend on the type of health insurance you get, and the features of each health insurance can vary from one another. But most health insurance covers the following factors. So, read on:

  • Ambulatory patient care (outpatient care you get without being admitted to a hospital)
  • Emergency services.
  • Pregnancy, Maternity, and More.
  • Mental health substance and treatment.
  • Prescription drugs.
  • Rehabilitative care.
  • Habilitative care.
  • Lab services.
  • Wellness services for chronic diseases.
  • Pediatric services.
  • Accidents.
  • Preventive care.
  • Dental coverages.
  • Birth control coverage.
  • Breastfeeding coverage.
  • Medical management program services.
  • Screening.
  • And More.

More things can be included in health insurance, but you might want to read the terms and conditions of the company before you jump into buying the insurance. Apart from these above-mentioned benefits, you also need to be sure about what health insurance will not cover.

What does a Health Insurance Not Cover

1) Cosmetic Surgery: Because this type of surgery is not life-threatening or dangerous, Liposuction, Botox, or comparable procedures are not covered by health insurance coverage.

2)Abortion: Abortion-related medical expenses are not covered by health insurance. Most insurance companies do not cover abortion costs unless it is absolutely necessary to save the mother’s life. In such a tragic occurrence, the case should be presented to the insurance company following certification by a medical practitioner. It should be noted that abortion is not covered by health insurance.

3) Pre-existing Diseases: This differs from one insurance company to the next. Some insurance companies do not cover high blood pressure and diabetes, while others do. Certain additional insurance firms provide coverage for pre-existing disorders if the insured maintains the policy for a significant amount of time, such as 12 – 48 months. Some insurers will cover the insured for pre-existing conditions if an additional premium is paid.

4) Miscellaneous Charges: Registration costs, admission fees, and service fees are not covered by a medical insurance plan.

5) Health Supplements: Health tonics and protein shakes that are not ingested by an individual to combat the disease are not covered by health insurance. However, if these supplements are suggested by a medical practitioner as part of treatment while the individual is hospitalized, they are covered by insurance.

These are the major factors that do not come under health insurance, and it is more important for you to check what does not come under insurance than what does. 


When you are buying health insurance, it is more than just critical to stress every term and condition. It can sometimes get tricky, and you might end up buying the wrong insurance. And when you know your insurance in and out, it is easier for you, and you can be fear-free.

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