What does Health Insurance cover?

What are the Inclusions of Health Insurance?

A health insurance policy covers different treatments and procedures. Below are some common features covered by health insurance policies.

• Annual Health Check-Ups – A free annual health check-up is a feature covered by maximum health insurance plans. This feature allows policyholders to avail of a free health check-up every year or every two years depending on the health policy.
   
• In-patient Hospitalization coverage – When a patient is admitted to a hospital for treatment, it is called “in-patient” hospitalization. A minimum of 24 hours stay in the hospital is considered under this feature and it is covered by most health insurance policies.
   
• Cashless treatment – Cashless treatment or cashless hospitalization is a facility offered by health insurance policies wherein the patient can avail of cashless treatment in a hospital without spending any money from his/her pocket. In this case, the insurance company settles the claim amount directly at the time of release of the patient from the hospital
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• Pre- and post-hospitalization costs – These are expenses incurred before and after the hospitalization of a patient. Depending on the insurance company and the health insurance plan, the insured gets a specific number of days that are covered under pre- and post-hospitalization costs.
   
• Daycare procedure – Daycare treatments are medical procedures that require less than 24 hours of hospitalization. These treatments require the patient to stay in the hospital for a few hours and it should be less than 24 hours. Most health plans cover these procedures.
   
• Tax benefits – Most health insurance policies offer a tax benefit as per the prevailing tax laws. So, the insurance policyholder can enjoy tax benefits for the premiums paid.
   
• Room rent – Most health insurance policies cover hospital room rent and ICU charges. However, some policy providers may levy a limit on the room rent and ICU charges, which should be considered before buying a policy.
   
• Critical Illnesses – Many health insurance policies cover critical illnesses either as a regular feature or as an add-on rider.
   
• Daily hospital cash – Daily hospital cash is also a key feature of health insurance policies which is covered under many insurance plans.
   
• Ambulance charges – Ambulance charges are also covered under health insurance policies. Depending on the plan, it may cover road or air ambulance for patients up to a certain limit.
   
• AYUSH treatment –Ayurveda, Yoga, Unani, Siddha, and Homeopathy (AYUSH) are also covered under health insurance plans.
   
• Maternity Benefits - There are several health insurances that cover pregnancy and childbirth. However, all health insurance policies may not offer maternity benefits. So, you have to check your policy wording to see if it covers maternity.
   
• Organ Transplantation – Organ transplantation and organ harvesting are also covered in most health insurance policies. This means if the policyholder needs an organ transplant, the cost of harvesting the organ and the cost of donor hospitalization is covered under the plan
   
• Pre-Existing Diseases (PED) – Pre-existing diseases are covered under health insurance policies after a waiting period that may range between 2-4 years depending on the policy.
   
• No Claim Bonus (NCB) – If a health insurance plan is not claimed by a policyholder during a particular policy year, the policyholder can get an NCB reward of 10 to 20 % per year for every claim-free year depending on the policy.

What are the Exclusions of Health Insurance?

Like the coverages, many features are not covered under health insurance policies, which are termed exclusions. Below are some exclusions of health insurance policy:

Cosmetic Procedures – Cosmetic treatments that are done to enhance body parts and improve appearances are also not covered under health insurance policies.

Mental Illness – Mental illness treatment also doesn’t come under the purview of health plans in the case of most health insurance policies.

HIV/AIDS – Treatment for HIV/AIDS is also not covered under most health insurance policies.

Fertility Treatments – Fertility treatments are not regarded as essential health treatments and hence many insurance providers do not offer coverage for such treatments.

Top Five Comprehensive Health Insurance Plans in India (category-wise)

Below are the top 5 Health Insurance policies in each category:

• Health Insurance with Maternity Cover

        1. Care Joy Tomorrow Plan
            Delivery Expense: INR 50,000
            Maternity Waiting Period: 2 years

        2. Aditya Birla Active Fit Preferred Plan
            Delivery Expense: INR 40,000 – INR 60,000
            Maternity Waiting Period: 3 years

        3. Niva Bupa Health Premia Plan
            Delivery Expense: INR 60,000
            Maternity Waiting Period: 2 years

        4. Tata AIG Medicare Premier Plan
            Delivery Expense: INR 50,000
            Maternity Waiting Period: 2 years

        5. Manipal Signa ProHealth Prime Advantage Plan 
            Delivery Expense: INR 1 lakh
            Maternity Waiting Period: 3 years

 

• Health Insurance with OPD Cover

        1. Aditya Birla Activ Health Enhanced Platinum Plan
            Sum insured: INR 2 lakh – INR 2 Crore
            OPD Cover: INR 5000 – INR 20,000

        2. Cholamandalam Family Healthline Plan
            Sum insured: INR 2 lakh – INR 15 lakh
            OPD Cover: N/A

        3. Care Family Health Insurance Plan
            Sum insured: INR 3 lakh – INR 6 lakh 
            OPD Cover: INR 5000 – INR 50,000

        4. Niva Bupa (Formerly known as Max Bupa) Go Activ Health Plan
            Sum insured: INR 4 lakh – INR 25 lakh
            OPD Cover: Up to 10 cashless OPD consultations

        5. SBI Arogya Plus Plan
            Sum insured: INR 1 lakh – INR 3 lakh
            OPD Cover: OPD Consultation/ Treatment cover
 

• Health Insurance with Dental Cover 

        1. Aditya Birla Activ Health Platinum Enhanced Platinum Plan
            Sum Insured: INR 15 lakh – INR 2 Crore
            Dental Cover: Dental Consultation/Investigation

        2. Chola MS Privilege Healthline Plan
            Sum Insured: INR 5 lakh – INR 25 lakh
            Dental Cover: Outpatient Dental Expenses INR 10,000 every 2 years

        3. Future Generali Health Total Plan
           Sum Insured: INR 15 lakh – INR 1 Crore
           Dental Cover: Outpatient Dental Consultations and Diagnosis

        4. ManipalCigna ProHealth Insurance Plan
            Sum Insured: INR 2 lakh – INR 1 Crore
            Dental Cover: Dental treatments 

        5. SBI Arogya Plus Plan
            Sum Insured: INR 1 lakh – INR 3 lakh
            Dental Cover: OPD Dental treatments

 

• Health Insurance with Cancer Cover 

        1. Aditya Birla Activ Cancer Secure Plan
            Sum Insured: INR 5 lakh – INR 1 Crore
            Waiting Period: 90 – 180 days

        2. Chola MS Critical Healthline Insurance Plan
            Sum Insured: INR 1 lakh – INR 10 lakh
            Waiting Period: 90 days

        3. Future Generali Criticare Plan
            Sum Insured: INR 1 lakh – INR 50 lakh
            Waiting Period: 90 days

        4. Liberty Critical Illness Insurance Plan
            Sum Insured: INR 1 lakh – INR 1 Crore
            Waiting Period: 90 days

        5. Niva Bupa Criticare Health Insurance Plan
            Sum Insured: INR 5 lakh – INR 5 Crore
            Waiting Period: 90 days