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What Does Health Insurance Cover?

Health insurance provides comprehensive coverage for medical expenses including hospitalization treatments and preventive care. Coverage includes various healthcare services with specific policy terms.

  • 05 Feb 2025
  • 4 min read
  • 89 views

In today’s era, a health Insurance plan is a necessity. A comprehensive healthcare plan provides coverage for a wide range of medical expenses, such as regular check-ups, pre- and post-hospitalisation expenditures, screening tests, domiciliary care, vaccinations, etc.

This brings us to the question, “What does health insurance cover?

If you already have a healthcare plan or are planning to purchase one yet wondering what’s in it for you, let’s delve deeper and understand what the inclusions of a comprehensive healthcare plan are. We will also look at the exclusions of a health insurance policy so you know what will not be covered.

Also Read - What is Health Insurance

What is Covered by Health Insurance

A healthcare policy covers various services, treatments, and procedures; however, the scope of coverage varies between insurers and the type of plan. All health insurance policies typically cover the following —

  • Hospitalisation: Health insurance covers expenses related to hospitalisation, including room rent, ICU and ITU charges, surgical procedures, doctor visits, etc.
  • Pre- and post-hospitalisation expenses: Policyholders are usually covered for the expenses incurred before and after hospitalisation, such as consultation charges and diagnostic tests. However, the number of days for which these expenses are covered varies between insurers.
  • Surgical procedures: Planned and emergency surgery are covered by healthcare plans. Insurers also cover ambulance charges and daycare procedures.

Exclusions of Health Insurance Cover

While health insurance covers many medical expenses, certain expenditures are not covered. The following is a list of some of them —

  • Cosmetic procedures: Health insurance does not cover Any cosmetic procedure that is not medically necessary and is done purely for a person’s beautification/aesthetic purpose. 
  • Fertility treatment: This is not covered by healthcare plans.
  • Treatment for sexually transmitted diseases: Treatment for such conditions is not covered by health insurance.

Treatment deemed unnecessary or elective procedures are also not covered by health insurance plans. Expenses related to dental and vision care may also be excluded, depending upon the type of health insurance policy.

Conclusion

You must review and understand your health insurance policy’s terms and conditions to know what is included and explicitly excluded from coverage. If you have any doubts, you can contact your insurer and seek clarification so that when the time to make a claim comes, you won’t have to face any unpleasant surprises.

 


Disclaimer: The information provided in this blog is for educational and informational purposes only. It may contain outdated data and information regarding the relevant industry. It is advised to verify the relevance of the data and information before taking any major steps. ICICI Lombard is not liable for any inaccuracies or consequences resulting from the use of this outdated information.

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