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Understand What A Health Insurance Policy Does And Doesn't Cover.

Updated On Jun 19, 2022

Health insurance is a sort of insurance that pays for medical costs incurred as a result of an illness. These charges might include hospitalization bills, pharmaceutical prices, or medical consultation fees. The cost of an insured person's medical and surgical expenditures is covered by health insurance. Depending on the conditions of the insurance policy, the insured may pay out-of-pocket and then be repaid, or the insurance company may repay costs immediately.

Understand What A Health Insurance Policy Does And Doesn't Cover.

What is covered by a health insurance policy?

  • Injuries Caused By Accidents

In most cases, all Mediclaim coverage cover the cost of treatment for injuries sustained in an accident. You may be covered for all expenditures, including inpatient hospitalization, post-hospitalization care, diagnostic testing, and so on, depending on the insurance terms. Additionally, if you receive treatment at one of the insurer's network hospitals, you can use the cashless claim facility to cover these fees.

  • Cancer

One of the most feared diseases is cancer. The cost of cancer therapy can range from thousands to millions of dollars, depending on the severity of the patient's illness and the type of cancer they have been diagnosed with. Patients with cancer may require specialized care, as well as prolonged hospitalization and post-hospitalization treatments such as chemotherapy and radiation therapy. In most cases, all health insurance policies cover cancer treatment, although there may be exclusions.

  • Surgery of Cataract

This is a common condition that is covered by health insurance. A cataract is an eye disease that impairs vision, and it is most common among older individuals. Cataract surgery is usually required for therapy. Most healthcare plans, with the exception of group health insurance coverage, include cataract surgery. However, there may be a period of time before the coverage kicks in.

What does a health insurance policy not cover?

Treatments not covered by a health insurance plan include:

  • Surgical procedures for cosmetic purposes

Cosmetic procedures such as Botox, Liposuction, implants, and other comparable procedures are not covered by health insurance. If you plan to have such surgery within the insurance period, you should verify with your insurer. Insurance companies do not cover such medical treatments unless they are part of the therapy.

  • Supplements for Health

The insurer does not give financial coverage for health tonics and supplements under your health insurance policy. If the treating physician recommends them, the costs may be reimbursable. However, if you take it without a prescription, it will not be covered by your insurance.

  • Overconsumption of alcohol-related diseases

If any condition is linked to excessive alcohol intake, such as liver damage or other issues, the insurance provider has the ability to deny your health insurance claim.

  • Expenses for Complementary and Alternative Therapies

Alternative therapies such as naturopathy, acupressure, naturopathy, acupuncture, reflexology, and other similar treatments are not covered by health insurance.

  • Complications of infertility and pregnancy

Hospitalization costs connected to infertility and pregnancy difficulties, such as abortions, are not covered by health insurance. These costs may be covered by certain maternity health policies, but they are not covered by basic health insurance. If you're seeking for coverage for pregnancy-related expenditures, review your policy's wordings.

Take Away

The disorders covered by health insurance vary depending on the coverage type. It's critical to understand the list of diseases covered by the plan, as well as the terms and conditions of coverage, before signing the policy documents. This will assist you in making an informed policy purchase and avoiding filing a fraudulent claim. So, to avoid a bad experience and better manage your budget, read your policy wordings all the way through to have a better understanding of the inclusions and diseases that are not covered by health insurance.

Also read: The Benefits Of Buying A Health Insurance Policy Online

What Are The Multiple Benefits Of Buying HDFC ERGO Health Insurance?


This article is issued in the general public interest and meant for general information purposes only. Readers are advised not to rely on the contents of the article as conclusive in nature and should research further or consult an expert in this regard.

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