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Diseases Covered Under Health Insurance

Coverage for ailments that require hospitalisation

Avail additional coverage through add-ons

Choose a policy with maximum diseases covered

Diseases Covered Under Health Insurance

Health insurance helps you deal with medical emergencies, be it an unfortunate accident or sudden illness. When it comes to covering treatment for diseases, the coverage may differ depending on the health insurance policy opted. Most common diseases that require hospitalisation or surgery are usually covered – but it is important to go through the policy terms and conditions to make the right choice.

Why It’s Important To Know the Diseases Covered?

You buy a health insurance policy believing you are safe against out-of-pocket expenses. You get admitted for an illness and, upon raising a claim, realise that the particular disease isn’t covered. Not an ideal situation. Knowing diseases covered by health insurance is essential to:

Avoid Surprises

A disease assumed to be covered may fall under exclusions, sub-limits, or waiting periods. It could lead to out-of-pocket expenses. Knowing the diseases covered in advance helps set realistic expectations.

Plan Healthcare Expenses Better

Knowing diseases covered by health insurance allows you to estimate potential medical costs more accurately. When you know which diseases are covered and which are not, you can plan your healthcare expenses better through savings or add-ons.

Choose the Right Policy

Every individual and family has different health risks based on age, lifestyle and medical history. Awareness of disease coverage helps you select a policy that meets your current and future healthcare needs.

List of Common Diseases Covered Under Health Insurance

Several conditions can lead to hospitalisation. A health insurance policy usually covers illnesses and medical conditions that require hospitalisation or day care treatment, unless specifically excluded. Go through the policy wording of your policy to know the list of diseases covered under health insurance.

What Are the Diseases Not Covered By Health Insurance?

When purchasing a health plan, be aware of the diseases your policy doesn’t cover. A health insurance policy generally doesn’t cover pre-existing ailments and their direct complications. Also, certain diseases may be covered after a waiting period. Refer to the policy wording for more information.

Critical Illnesses Covered Under Health Insurance

Critical illnesses result in significantly higher expenses. Health insurance policies do cover critical illnesses through optional covers or add-ons. Though the list may differ across policies, the ones generally covered are:

Cancer of specified severity
Coronary artery disease
Surgery to aorta
Kidney failure requiring regular dialysis
End-stage lung disease
End-stage liver failure
Terminal illness
Bacterial meningitis
Coma of specified severity

Go through the policy wordings carefully to know in detail.

Pre-existing Diseases and Their Waiting Period

Pre-existing diseases are conditions you had before buying a health policy. While a health insurance policy does cover them, they are covered after a certain time. It's called the waiting period. Depending on the disease, the waiting period could range from a few months to years.

Diseases Covered After the Waiting Period

While specifics may differ across policies, generally, the following diseases are covered after a waiting period:

Haemorrhoids
Dysfunctional uterine bleeding
Stones in the urinary and biliary systems
All types of sinuses
Cataracts
Hysterectomy
Diabetes
Hypertension
Cardiac conditions

Read the policy wording carefully to know the complete list.

Coverage For Vector-Borne and Seasonal Diseases

Several vector-borne and seasonal diseases occur at specific times of year. If you are down with any such ailment and need hospitalisation, your health insurance policy comes to your rescue. It pays for the hospitalisation expenses you incur for the treatment of such diseases. It ensures you don’t have to dip into your savings for treatment.

Maternity and Newborn-Related Diseases Covered

Welcoming a new family member is always special. With proper planning and financial preparedness, you can ensure that both the mother and the baby remain healthy. Maternity benefit(s) and newborn baby cover are available through add-ons or optional covers. By paying an additional premium, you get coverage for prenatal and postnatal expenses.

Tips to Choose a Plan With Maximum Disease Coverage

Opting for a health policy covering maximum diseases requires patience and discipline. To do so:

Compare Policies

Compare multiple policies and check the list of covered diseases for each. Make sure common illnesses and serious conditions are covered. It broadens your safety net.

Look At Waiting Periods

Many diseases are covered only after a waiting period. Shorter waiting periods are better, especially for pre-existing illnesses. Always compare how long you need to wait before coverage starts. It's important if you need treatment soon.

Understand the Exclusions

Every health insurance plan has exclusions. Read the list of diseases and treatments that are not covered. Knowing this in advance helps you avoid surprises. It also lets you decide whether you need an add-on or a different policy.

How to File a Claim For Disease Treatment?

Want to file a claim? There are two ways to do so - cashless and reimbursement. For cashless claim:

Get treated at the network hospital and submit a copy of your health card and submit a copy of your health card at the hospital third-party administration (TPA) desk
The hospital contacts your insurer for cashless approval along with the necessary documents
The insurer processes the request as per the policy’s terms and conditions

For reimbursement claims, complete the claims form and provide all required documents. The insurer reviews the form and the submitted documents and settles your claim in accordance with the applicable terms and conditions.

List of Cashless Hospitals

Cashless hospitals ensure you get treated without making any upfront payments. Every insurer has a network of empanelled hospitals where you can avail of cashless treatment. The list is available on your insurer’s official website / app. However, note that insurers regularly update the list.

Frequently Asked Questions About Diseases Covered Under Health Insurance

What diseases are usually covered under health insurance?

Most health insurance plans cover common illnesses that require hospitalisation. Coverage for critical ailments is available through add-ons. The exact list of diseases covered varies across policies.

Are all diseases covered from the first day of the policy?

No, not all diseases are covered from day one. Many policies have waiting periods for certain illnesses, pre-existing diseases and specific treatments. It is important to check these waiting periods before buying a plan.

Can a claim be rejected even if the disease is covered?

Yes, a claim can be rejected if policy conditions are not met. It can happen due to non-disclosure of medical history, incomplete documentation, or treatment during the waiting period. Understanding policy terms helps reduce the chances of claim rejection.

Health insurance articles

Health Diseases Blogs

Slow Growing Disease List in Health Insurance

Slow-growing diseases progress gradually and often require continuous care, monitoring, and lifestyle management. This article explains their symptoms, diagnosis, treatment approach, and how insurance policies apply waiting periods, pre-existing condition rules, and coverage eligibility over time.

23 Feb 2026

Health Diseases Blogs

List of Pre-Existing Diseases in Health Insurance: Complete Guide

This blog covers meaning of PED, common pre-existing illnesses, waiting periods, premium impact, disclosure rules, risks of non-disclosure and how to choose a plan with PED cover.

19 Feb 2026

Health Diseases Blogs

Hepatomegaly - Causes, symptoms & treatment

This article explains hepatomegaly (enlarged liver), covering its causes, symptoms, and treatment options. It highlights how early diagnosis, proper management, and lifestyle changes can help control the condition. The article also discusses the importance of having health insurance to cover hepatomegaly-related treatments, tests, and hospitalisation costs.

30 Nov 2025

Health Diseases Blogs

How Often Should You Have a Pap Smear Test?

This article explains the recommended frequency of pap smear tests, highlighting risk factors that may require more frequent testing, and the importance of regular screenings for womens health.

14 May 2025

Health Diseases Blogs

Symptoms of Norovirus Disease

Norovirus symptoms include nausea, vomiting, diarrhea, stomach cramps, and are managed with hydration and rest.

13 May 2025

Health Diseases Blogs

Symptoms of Sarcopenia Disease

Sarcopenia symptoms include muscle weakness, reduced stamina, and difficulty in daily activities, managed with exercise.

13 May 2025

Health Diseases Blogs

Causes of Sarcopenia Disease

Sarcopenia is caused by aging, inactivity, poor nutrition, and chronic diseases affecting muscle strength and mass.

13 May 2025

Health Diseases Blogs

What Is the Treatment for Kidney Stones

Kidney stones are treated with pain management, hydration, medications, and sometimes surgical removal procedures.

13 May 2025

Health Diseases Blogs

What Is the Treatment for Vertigo

Vertigo is treated with vestibular therapy, medications, balance exercises, and addressing the underlying cause.

13 May 2025

Health Diseases Blogs

What Is the Treatment for Leprosy

Leprosy is treated with multi-drug therapy (MDT) involving antibiotics like dapsone, rifampicin, and clofazimine.

13 May 2025

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Diseases Covered Under Health Insurance

Diseases Covered Under Health Insurance

Why It’s Important To Know the Diseases Covered?

Avoid Surprises

Plan Healthcare Expenses Better

Choose the Right Policy

List of Common Diseases Covered Under Health Insurance

What Are the Diseases Not Covered By Health Insurance?

Critical Illnesses Covered Under Health Insurance

Pre-existing Diseases and Their Waiting Period

Diseases Covered After the Waiting Period

Coverage For Vector-Borne and Seasonal Diseases

Maternity and Newborn-Related Diseases Covered

Tips to Choose a Plan With Maximum Disease Coverage

Compare Policies

Look At Waiting Periods

Understand the Exclusions

How to File a Claim For Disease Treatment?

List of Cashless Hospitals

Frequently Asked Questions About Diseases Covered Under Health Insurance

What diseases are usually covered under health insurance?

Are all diseases covered from the first day of the policy?

Can a claim be rejected even if the disease is covered?

Health insurance articles

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