Health Insurance Plans

pays for your hospital bills for diagnostics, surgery etc.

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What is covered and what is Not in Health Insurance?

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Everyone is subjected to health risks at one point of time in their life. Health Insurance is helpful to cover the unexpected expenses such as medical and Hospitalization cost. It not only covers individual but also the whole family against the financial loss caused due to medical emergencies. Today, medical expenses are so high and spending a lump sum amount suddenly is not possible for everyone. If you take a health insurance you can pay an affordable Premium periodically based on the sum Assured and this would help to cover the heavy medical expenses.

Also, one should know what is covered and what is not in health insurance. By doing so, you can enjoy the medical insurance benefits to the fullest.

What is covered in medical 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 on showing this card on the networked hospital, he/ she can avail cashless facility meaning insurance holder need not pay anything to the hospital. The Insurer would have a tie up on almost all the hospitals already to facilitate cashless facility.
  • Hospitalization cash benefits: Every day hospitalization expenses are covered to reduce the financial burden of the insurance holder. This would be great help to the insured as this amount would compensate the loss of earnings and other costs.
  • Pre and post hospitalization costs: Usually pre and post hospitalization expenses are covered up to 60 to 90 days and some insurance company even approve up to 140 days.
  • Ambulance charges: Even ambulance charges are covered by some insurance company and the insurance holder need not worry about those charges.
  • Health checks up: In case there is no Claim for certain number of years, some company even provides free health check up to the insured.
  • Pre existing diseases: Usually pre existing diseases are not covered under health insurance policy; however diabetes is covered if the insured renews the Policy for 3 or 4 consecutive years.

What is not covered in medical insurance?

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

  • Pre existing diseases:Pre existing diseases are which you may have had prior taking the policy such as high blood pressure diabetes etc will not be covered under the health insurance policy; also the complications arising in the future due to pre existing diseases would not be covered. However some companies do cover pre existing diseases after continuous renewal of policy without any breaks.
  • Some specific medical condition: Some medical conditions such as hernia, cataract, gall bladder stone removal, calculus diseases, hydrocele, joint replacement, sinusitis, Fibromyoma, Benign prostatic hypertrophy, piles, fistula in anus and age related ailments like Osteoarthritis and Osteoporosis are not covered for a specific period of time, this time duration is different in each insurance company.
  • Cosmetic surgery: Cosmetic surgery are usually not covered in health insurance as it does not affect an individual life and it is not life threatening.Cosmetic surgery like liposuction, Botox and others are not part of the health insurance cover.
  • Abortion:Abortion is still in debate, whether to legally approve it or not so it is excluded from the health insurance package.
  • Pregnancy:Pregnancy treatment and any emergency arising in due course like caesarean section are not covered under health insurance.
  • Cost for Alternative therapy: Alternative therapy like massage, aromatherapy, reflexology, acupuncture, acupressure, naturopathy and other related therapies are not supported since these are not part of conventional medicines.
  • Diagnostic charges:Diagnosis charges to identify the presence of the diseases performed at hospital or nursing home are not usually payable by medical insurance.
  • Extra charges:Service charge, registration fees, admission fees and any other additional charges would not be reimbursed in medical insurance.
  • Supplements:Costs for vitamins and other health tonics which are not part of the treatment for any disease or injury is not considered for reimbursement.However, if these supplements are given by the physician for the part of the treatment when a person is hospitalized, then it would be covered in medical insurance.

It is imperative for every insurance holder to read the terms and conditions carefully to know the exclusions. Also, one should note the medical conditions not supported by the insurance company. It is the responsibility of the insurance holder to find what is covered and what is not in health insurance, so that they can avoid unnecessary insurance claims.