Health Insurance is taken out to cover the cost of medical care of the insured person

health insurance

Health insurance is a type of insurance coverage that covers the medical and surgical expenses of an insured person. Depending on the type of health insurance coverage, the insured person pays the costs and receives the reimbursement, or the insurer makes the payments directly to the provider.

Everyone is exposed to health risks at some point in their life. Health insurance is useful for covering unforeseen costs such as medical and hospital expenses. It covers not only people but also the whole family, against the financial losses caused by medical emergencies. Today, the medical costs are so high and it is impossible for everyone to spend a lump sum. If you take out health insurance, you can periodically pay an affordable premium based on the insured amount, which would cover the heavy medical expenses.

In addition, you must know what are the diseases covered and what is not covered in health insurance. In doing so, you can fully enjoy the benefits of health insurance and have hassle-free claims.



10 Points to check before taking Health Insurance

10 Points to check before taking Health Insurance

Which Diseases are Covered in Health Insurance?

Besides covering the medical expenses there are other benefits covered by the Mediclaim policy:

  • Cashless Facility: The insurance company issues an identity card to the Insured and, by presenting it to the networked hospital, s/he can use this money, which means that the insured person has to pay nothing to the hospital. The insurer would already have a bond on almost all hospitals to facilitate the structure without money.
  • Cash benefits for hospitalization: Hospital costs are covered daily to reduce the financial burden of the policyholder. This would be of great help to the insured as this amount would offset the loss of earnings and other costs.
  • Pre- and post-hospitalization costs: In general, pre- and post-hospital costs are covered for 60 to 90 days and some insurance companies also approve up to 140 days.
  • Ambulance fees: Ambulance costs are also covered by an insurance company and the insured does not have to worry about these expenses.
  • Health Checks: In the absence of a claim for several years, some companies also offer a free health check to the insured.
  • Pre-existing diseases: Pre-existing diseases are not usually covered by the health insurance policy; however, diabetes is covered if the insured renews the policy for 3 or 4 consecutive years.

Which Diseases are NOT Covered in Health Insurance?

Even though medical insurance covers the unforeseen medical emergencies, there are limitations to the policy:

  • Pre-existing conditions that you may have had before taking action such as hypertension, diabetes, etc. Such diseases will not be covered by the health insurance policy; even future complications due to pre-existing diseases would not be covered. However, some companies cover pre-existing illnesses after continuous policy renewal without interruption.
  • Specific medical conditions: Certain medical conditions such as
    1. Hernia,
    2. cataract,
    3. gallbladder removal,
    4. tartar disease,
    5. hydrocele,
    6. joint replacement,
    7. sinusitis,
    8. fibromyoma,
    9. benign prostatic hypertrophy,
    10. mucous membranes,
    11. anal fistulae and
    12. age-related disorders such as osteoarthritis and osteoporosis, are not covered for a certain period of time. This duration is different in each insurance company.
  • Cosmetic Surgery: Health insurance does not usually cover cosmetic surgery because it does not affect the lives of individuals and does not endanger life. Cosmetic surgery such as liposuction, Botox and others is not part of the health insurance coverage.
  • Abortion: Abortion is still under discussion, whether legally approved or not, so it is excluded from the health insurance package.
  • Pregnancy: Pregnancy treatment and timely emergencies, such as cesarean section, are not covered by health insurance.
  • Cost for Alternative therapy: Alternative therapies such as massage, aromatherapy, reflexology, acupuncture, acupressure, naturopathy, and other related therapies are not supported because they are not part of conventional medications.
  • Diagnostic charges: The costs of diagnosis to identify the presence of diseases practiced in the hospital or in a retirement home are generally not the responsibility of the medical insurance
  • Extra charges: The cost of the service, registration fees, entrance fees, and any other additional costs will not be reimbursed in health insurance.
  • Supplements: Costs for vitamins and other health products that are not part of the treatment of any illness or injury are not taken into account for reimbursement. However, if these supplements are provided by the doctor for the part of the treatment when a person is hospitalized, he will be covered by medical insurance.
  • War/Invasion Injuries: The costs of treatment for illness or accident incurred/suffered directly or indirectly by war, invasion or acts of a foreign enemy will not be covered.
  • Cost of Aid: visual treatments, hearing aids, contact lenses, glasses.
  • Dental treatment or surgery without hospitalization.
  • Intoxicants: Treatment of self-injury and injury/illness caused by the use of intoxicants.
  • STD: Any direct/indirect treatment related to AIDS, circumcision.
  • Cosmetic: Aesthetic or cosmetic care.
  • Pregnancy: Intentional interruption of pregnancy and childbirth.
  • Rehabilitation Centres: Natural therapies, natural cures, and wellness centers.
  • Hereditary: Conditions of dependence and hereditary disorders and conditions.
  • Injuries sustained: Injuries suffered as a result of participating in adventures or dangerous sports.
  • Others:
    – Aging, puberty, and obesity.
    – Alternative treatment, maintenance of artificial life, medical card fees.
    – Convalescence and rehabilitation.
    – Drugs, drugs for treatment by OPD or take home.
    – Preventive assistance or reproductive medicine.
    – Treatment received outside India, hospital/doctor not recognized, experimental/unproven treatment, cost of diagnosis unrelated to illness/injury

Permanent Excluded Treatments in Health Insurance

Permanent Excluded Treatments in Health Insurance

 Diseases Declined In Health Insurance

 Diseases Declined In Health Insurance

Conclusion:

With the steady rise in the cost of health and lifestyle-related diseases, health insurance has become a necessity for all.
Additionally, it’s imperative that each insured person carefully reads the terms and conditions for exclusions. And also must note the medical conditions or diseases not covered by the insurance company.
It is the responsibility of the insured to find what is covered and what is not covered in the health insurance, to avoid unnecessary claims hassle for compensation.

FAQ’s

Q. What is ‘Anyone illness’?

Answer “Anyone illness” means the continuous period of illness, including relapses within a certain number of days as specified in the policy. Usually, it’s 45 days.

Q. ​​​What is pre-existing condition in health insurance? 

Answer This is a medical condition or illness that existed prior to obtaining the health insurance policy and is important because the insurance companies do not cover these pre-existing conditions in the 48 months preceding the 1st policy. This means that the payment of pre-existing conditions can be taken into account after 48 months of continuous insurance.

Q. What is “health check” facility?

Answer Some health insurance policies pay for specified expenses towards general health check-up once in a few years. Normally this is available once in four years. 

Q. What are the diseases covered under health insurance? 

Answer Diseases such as cataracts, kidney stones, joint treatments and arthritis are considered pre-existing conditions and it is best to disclose them when buying the policy. Health insurance only covers hospital costs and serious critical illnesses require critical illness cover.

Q. What surgeries are covered by insurance? 

Answer Types of procedures include the use of aspiration, ultrasound, water or laser. Reconstructive surgery is considered medically necessary and covered by most health insurance plans.

Q. Is there any Waiting Period for claims under a policy?

Answer Yes. When you receive a new policy, there is a 30-day waiting period from the policy start date during which the hospitalization costs will not be borne by the insurance companies.
However, this does not apply to emergency hospitalization due to an accident. This waiting period will not apply to subsequent policies in the renewal phase.

Created by,

Rishabh Mishra

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