Health insurance is most commonly referred to as medical insurance, which generally covers the costs of surgical and medical expenses of an injured or sick individual. Therefore, insurance companies either pay directly to the care providers, or reimburse the treatment expenses of the insured person. Before purchasing a health insurance plan, the inclusions and exclusions must be studied very well. These may vary across insurers.
Some of the health insurance inclusions in India are listed below:
1) In-patient hospitalization: A person does not even need hard cash to start hospitalization and treatment. It is possible for them to avail in-patient hospitalization. Expenses such as doctor fees, nursing expenses, room charges, and ICU are included in the health insurance plans in most cases – depending on their claim type and amount.
2) Pre-hospitalization and post-hospitalization: The pre-hospitalization expenses as well as the post hospitalization expenses such as treatment, doctor fees, follow-ups, etc. are covered under these plans.
3) Annual health check-ups: Many health insurance plans in India provide annual check-ups to policyholders. These generally include tests such as kidney function, blood sugar/diabetes, ECG check-ups and so on. Therefore, insured members under medical insurance policies are able to avail annual health check-ups once a year.
4) NCB (No Claim Bonus): This refers to the reward provided by the insurance company or the health insurer to the policyholder for a claim free year. The bonus amount gets accumulated to the sum assured for every claim free year. There are generally two different types of claim free bonuses, and these include cumulative bonuses and discounts on the renewal of the premium.
5) Day care treatment: This is yet another inclusion in the health insurance plan. Daycare treatment refers to treatments which do not require the policyholders to be hospitalized for 24 hours. Therefore, daycare treatment includes chemotherapy, cataract surgery, dialysis as well as many other operational services.
Exclusions in health insurance
In health insurance, ‘exclusions’ are most commonly referred to as medical conditions or healthcare expenses, which are not covered by the insurer. Just as much as it is important to read about the inclusions, it is a must for policyholders to know about the exclusions as well. Some of the commonest health insurance exclusions are discussed below:
1) Pregnancy and related conditions: Pregnancy, abortion, childbirth, as well as any other treatment arising from pregnancy or traceable to it, are generally not covered under a health insurance plan. However, it is possible to get cover for pregnancy in certain health insurance plans, but only after a waiting period.
2) Pre-existing health conditions: If a person has already been suffering from a medical condition or illness before purchasing a health insurance policy, then it would not be covered under the same. This is referred to as pre-existing conditions, and may only be covered after a waiting period of more than 2-4 years, depending upon the illness, its type, and risks.
3) Dental, vision and hearing: Even if there are certain exceptions, both vision and dental procedures are usually not covered by health insurance policies, as hospitalization is not required in most cases. The same applies for most hearing treatments. However, these benefits may be purchased by the policyholders as additional riders to the existing health insurance plan.
4) Cosmetic surgery: Cosmetic surgery is generally performed on a person to enhance their appearance, and therefore, not all types of cosmetic surgeries are covered under medical insurance. However, in case of serious injuries, and accidents, it is possible to get a cover for cosmetic surgery under a health insurance plan although you should check for this aspect carefully beforehand.
Health insurance is the need of the hour and is absolutely non-negotiable today. Yet, prior to purchasing your policy, make sure that you go through all these inclusions and exclusions with care.
0
