Common Inclusions of Health Insurance
Common Inclusions of Health Insurance
Published on July 17, 2023. EST READ TIME: 3 minutes
Health insurance is an essential aspect of financial planning as it provides individuals and families with much-needed coverage against unexpected medical expenses. However, when it comes to selecting a health insurance plan, it’s crucial to understand the various terms and conditions associated with it. The policy contains inclusions and exclusions that determine what services and treatments are covered and what are not. It is essential for prospective buyers to carefully review these inclusions before making a decision. Let’s explore why checking the health insurance inclusions is vital and how it can help individuals make informed choices about their healthcare coverage.
Key Inclusions of Health Insurance
Some of the key health insurance inclusions include:
• In-patient hospitalisation
Expenses incurred during your hospitalisation of 24 hours or more are covered. These expenses include doctor consultation charges, diagnostic tests, room rent, ICU charges, OT charges, nursing care, the cost of medicines, etc.
• Pre- and post-hospitalisation
Before you get admitted to the hospital, the pre-hospitalisation expenses, such as the cost of diagnostic tests, medicines, doctor consultations, etc., are covered up to 30, 60, or 90 days of admission. Similarly, post-hospitalisation expenses like follow-up visits, medicines, physiotherapy, diagnostic tests, etc., are covered for up to 180 days. The number of days of both pre- and post-hospitalisation coverage depends on the insurance provider.
• Day Care procedures
These are surgeries and treatments which are wrapped up in less than 24 hours. Chemotherapy, cataract surgery, and dialysis are some day care treatments.
• Domiciliary hospitalisation
If the doctor recommends domiciliary hospitalisation or home treatment due to the non-availability of hospital beds or if the insured is not in a condition to be shifted to the hospital, your health insurance will cover the expenses.
• Organ donor expenses
If an insured requires organ transplant surgery, the cost incurred for harvesting an organ from the donor for transplantation is covered.
• AYUSH treatment
If you believe in alternative medicine treatments like Ayurveda, Yoga & Naturopathy, Unani, Siddha, and Homeopathy (AYUSH), health insurance will cover the treatment costs. However, the coverage is for in-patient hospitalisation, and treatment should be done at a government hospital or institute recognised and/or accredited by the Quality Council of India or the National Accreditation Board for Hospitals & Healthcare.
• Annual health check-ups
Health insurance plans offer free annual preventive health check-ups, which include tests like ECG, blood sugar, lipid profile, etc. Preventive check-ups help in early detection and treatment of any ailment.
• Mental healthcare
All health insurance companies are mandated by the IRDAI to cover hospitalisation expenses for treating mental illnesses like depression, anxiety, bipolar disorders, dementia, schizophrenia, etc.
• Pre-existing diseases
These medical conditions are covered after a waiting period of 2-4 years. If you have any pre-existing diseases while buying health insurance, make sure you disclose them to avoid any claim rejections in the future. If the insurance provider finds out you have hidden your medical history, your claims can be denied.
• Maternity Benefit
Healthcare policies in India typically cover pregnancy-related costs after a waiting period ranging between 9 months and 6 years. Prenatal and postnatal care, normal and caesarean deliveries, and expenditures associated with caring for a newborn are all covered.
Why Should You Check Inclusions of a Health Insurance Plan Before Buying?
Before signing up for a health insurance plan, checking the health insurance inclusions is important. These refer to medical expenses incurred on treatments, diagnostic tests, medicines, surgeries, and other healthcare services covered by your insurance provider. Being aware of the inclusions will help you understand the extent of the policy coverage and financial protection that the plan will provide. The purpose of a healthcare plan is to provide adequate financial security, and if your plan doesn’t have sufficient coverage, you will end up paying more out-of-pocket expenses. If you are unaware of the inclusions and raise a claim for any treatment the policy doesn’t cover, your claim will get rejected.
Checking the health insurance inclusions before buying a health plan will help you make an informed decision, as you can buy a policy that meets your medical needs. You can also avoid unpleasant surprises at the time of claim settlement. The inclusions vary from insurer to insurer.
Conclusion
It can be disappointing when your claim gets denied because the medical condition does not fall under the Inclusion of your health insurance plan. To ensure you have appropriate coverage, you must read and understand the inclusions as well as limitations and exclusions of your healthcare plan before buying it. Familiarising yourself with the inclusions to understand the extent of coverage will help you stay prepared for any emergency.
Disclaimer : The above information is for illustrative purpose only. For more details, please refer to policy wordings and prospectus before concluding the sales
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