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What Does Health Insurance Cover

Updated On Jun 26, 2022

It is suggested that you do your research and planning before selecting a health plan. It will help you choose a health insurance policy that has minimal exclusions and offers maximum coverage. Furthermore, medical insurance plans would generally exclude certain illnesses from the first year of coverage and cover it after the waiting period is over.

What Does Health Insurance Cover

There are certain standard sets of exclusions like the cost of contact lenses, spectacles, and hearing aids that are not covered. Also, dental surgery/ treatment ( unless requiring hospitalization), congenital external defects, convalescence, venereal disease, general debility, use of intoxicating drugs/alcohol, Self-inflicted injuries, AIDS, diagnosis expenses, infertility treatment, and Naturopathy treatment make a list of exclusions under health insurance plans in India.

What Is Covered Under A Health Insurance Policy?

Accident-related injuries

Typically, all Mediclaim policies cover the treatment cost for accident-related injuries. Depending on the policy terms, you can get full coverage for the expenses, including inpatient hospitalisation, post-hospitalisation care, diagnostic tests, etc. Additionally, you can avail the cashless claim facilities for such costs provided you avail treatment at any of the insurer’s network hospitals.

Cataract surgery

This is one of the common diseases covered under health insurance. A cataract is an eye-related ailment that affects the vision, and it mainly occurs among senior citizens. Typically, the treatment of cataract requires surgery. Except for the group health insurance policies, most healthcare plans cover cataract surgery. However, there may be a waiting period before the cover applies.


Cancer is one of the most dreaded diseases. Depending on the seriousness of the patients’ condition, and the type of cancer they are diagnosed with, the treatment cost for cancer can run into several lakhs. Cancer patients often require special care and prolonged hospitalisation and post-hospitalisation treatment like chemotherapy, radiation therapy, etc.

Typically, all health insurance plans cover cancer treatment, but they may be subject to terms and conditions. For example, if the cancer is detected in the late stages, the policy may have sub-limits on the hospitalisation expenses, or there may be a waiting period before it comes under the policy inclusions’ gamut. Be aware of the policy terms while filing the claim.


With the rising number of COVID-19 cases in India and the increasing risk of the disease, the Insurance Regulatory and Development Authority of India has mandated all the insurance companies in India to cover COVID-19 under the current policy. COVID-19 is a deadly virus, and its treatment requires specialised care. With a robust health insurance policy at hand, you can breathe a sigh of relief knowing that the insurer will take care of the treatment cost.


This is one of the common diseases covered under health insurance. Although not a serious condition, sometimes, if left untreated, it can lead to fatal consequences. Most insurance policies cover Dengue reimburse all medical costs incurred on the treatment, irrespective of whether you need hospitalisation or not; the policy also covers daycare expenses.


Diabetes is a common health problem among both men and women. Depending on the personal health condition, the disease can cause various complications, and often the patients may need to be hospitalized. Depending on your policy terms, you can get coverage against all expenses, including the blood tests, insulin shots, doctor consultation fees, medicines, etc.


So, to avoid going through such a negative experience and manage your finances better, read your policy wordings till the end to have better clarity on both the inclusions and the diseases that are excluded from health insurance scope of coverage.

Also Read: How Can Health Insurance Help In Saving On Taxes

The Benefits Of Buying A Women's Health Insurance Policy!


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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