Are Diagnostic Charges Covered by Health Insurance Policy in India?


4 min read

Does Health Insurance Policies Cover Diagnostic Expenses

When you are buying a health insurance policy it is important to make sure that it covers the various diagnostic expenses that arise in your life.

The term diagnostic test means the various tests – invasive and non-invasive – that we have to take to confirm if we have any health risks. They are also used to rule out the possibility of the same. Now, the costs of these tests tend to vary and several factors come into play. This includes the likes of method and the kind of equipment used to conduct the diagnostic test, to name a few.

Most Common Diagnostic Tests in India

Some of the commonest diagnostic tests include the following:

  • MRI (magnetic resonance imaging)
  • x-rays
  • ultrasound
  • mammography
  • CT (computed tomography) scans
  • fluoroscopy
  • PET (positron emission tomography) scans
  • blood samples
  • colonoscopies
  • biopsies

So, before you buy any health insurance plans it is important to find out if they are covering the above mentioned tests, and various other related details. The thing with these checkups is that they can cost you anywhere between thousands of rupees and hundreds of them. Thus, if you have a family member who is ill or if you have a pre-existing disease, you need to know these costs.

Would I get coverage for these expenses?

The good thing is that you would indeed get coverage for the same. If you buy the best health insurance there should be no need for you to worry in this regard. In any case, most of the health insurance policies these days cover the majority of these tests especially the x-rays, MRIs, and blood tests. However, they are covered only when you – the policyholder – got them done while you were at the hospital. Also, there is a minimum duration for which you have to stay at the hospital for your expenses to be eligible for coverage.

In some cases, this could be 24 hours at the very least. So, before you purchase any health insurance coveragemake sure that you have total clarification on such matters. Usually, if you get these tests done as an OPD (outpatient department) patient it would not be covered by your health insurance plan. However, there are some exceptions to this norm as we would discuss now.

How to save money on diagnostic expenses? 

If you are not getting any assistance from your health insurance coverage in India for such expenses it can get really tough indeed. This is because no matter what the test is, it can put quite a strain on your finances. This is especially true for people who are older than 40 to 50 years as well as ones who are responsible for a lot of people in their families. As we have discussed already, these plans cover diagnostic expenses only when you have been hospitalized for at least a day. Apart from that, in general, a health insurance plan would not cover any such test that you get done as an OPD patient.

However, there are also ways in which you can get claim benefits for these tests even when you were not hospitalized. We would discuss them right now. The first of them is to buy OPD coverage along with your health insurance policy. A lot of insurers are offering these add-ons nowadays so that their clients can claim coverage for such expenses other than when they were hospitalized. This includes the money that you spend at the pharmacies, the costs that you incur during diagnostic tests, and the other health check-ups that you have to get done from time to time.

The coverage that you get in this case depends on the insurer from which you bought the health insurance plan. In most of these plans where you have such coverage, you can claim reimbursement several times during the period when you are covered by the policy. Thus, you can save a lot of money on various diagnostic expenses. Apart from this, you can go for preventive check-ups. You can choose a package with such coverage based on the needs that your family may have.

This will help you keep an eye on the various ailments that members of your family may be suffering from. When you have the best health insuranceyou can expect such coverage with ease. One of the best things about such coverage is that you would be able to get it done within an economical premium structure. This way, you would also be able to notice any condition that may otherwise be hard to detect. In fact, several health insurance policies in India are offering such preventive health check-ups for free to their clients when they renew the policy.

These check-ups include the likes of the following:

  • lipid profile
  • Pap smear
  • pelvic exam
  • eye examination
  • cancer screenings
  • heart disease screening
  • dental exam

So, when you have such great health insurance coverage you do not at least have to bother about staying in great shape. The precise coverage that you get in these cases though would depend on the policy that you have bought. Section 80D of the Income Tax Act of 1961 states that if you are 60 years old you would get a maximum tax exemption of 25,000 rupees a year for investing in these policies.

Read More: 5 Best Tips For Buying Health Insurance Plans Online


So, when you try to buy health insurance coverage in Indiamake sure that they cover these diagnostic tests as well. This is because these are fundamental expenses and also one of the most important sums that you spend in your life. However, as you have seen so far, you can easily minimize these expenses with the likes of OPD coverage. These health insurance policies offer you several benefits apart from the reimbursement benefits such as tax benefits and related exemptions. All you have to do is be smart about investing some of your time and you would get the best healthcare within your budget.

May 30, 2022
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PayBima Team
PayBima is an Indian insurance aggregator on a mission to make insurance simple for people. PayBima is the Digital arm of the already established and trusted Mahindra Insurance Brokers Ltd., a reputed name in the insurance broking industry with 17 years of experience. PayBima promises you the easy-to-access online platform to buy insurance policies, and also extend their unrelented assistance with all your policy related queries and services.

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