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Health Insurance 101 views March 11, 2021
Considering the rising cost of medical treatment, it is important to have a health insurance plan that can provide timely financial help during a medical crisis. But people ask one question before choosing a plan — What exactly is covered in health insurance? A health insurance plan will cover the medical expenses up to the sum insured chosen by you. And it can vary from one policy to another. So, you need to understand what is covered under a health insurance plan before choosing the same.
Before getting into the details, let’s look at some of the key things covered in a health insurance plan.
Want to know more about all of them? Well, in this article, we will be discussing each of them so that you can make a better decision while choosing the right plan for yourself and your family. Keep reading!
Table of Contents
Buying a health insurance plan can be one of the smartest financial decisions that an individual can take as it will cover the different types of expenses during a medical emergency. Let’s know the things that are covered in a health insurance plan. We are starting with pre-and post-hospitalization expenses.
With health insurance, you will get coverage against the expenses incurred during the period before and after an individual gets hospitalized. This period generally ranges from 30 to 90 days and may change from one policy to another. So, you should check this before choosing a plan. Pre-hospitalization expenses generally include a blood test, urine test, x-ray, etc. while post-hospitalization expenses (after getting discharged from the hospital) include various medicines, follow-ups, tests, etc.
The best part is that individuals can receive coverage against hospitalization expenses due to an accident right from the day when you purchase a plan from an insurer. For any other hospitalization, you will need to serve a definite waiting period after which you can get the coverage for in-patient hospitalization. To claim for in-patient hospitalization expenses, an individual should be admitted to the hospital for a minimum of 24 hours.
Health insurance plans also provide coverage against the expenses incurred on daycare treatments. These treatments do not require minimum 24-hour hospitalization. Instead, it can be done in a few hours and individuals get discharged on the same day. Some of the most common daycare treatments are bone fracture and joint-related surgeries, certain injury-related dental surgeries, coronary angiography, nasal sinus aspiration, cataract surgery, tonsillectomy, chemotherapy, radiotherapy, etc.
With a few health insurance plans, you can also get coverage against the expenses incurred on the outpatient treatment. Under these treatments, individuals don’t need to get admitted to a hospital for the treatment or the diagnosis. One of the examples of OPD Treatment can be Root Canal Treatment. Do remember that the OPD treatment coverage is not standard across all health insurance plans.
With specialized health insurance plans made for people suffering from critical illnesses, individuals can get coverage against all the expenses incurred on the treatment. Some of the critical illnesses are cancer, kidney failure, heart attack, major organ transplantation, multiple sclerosis, etc. Remember that the coverage will start once the waiting period is over. The norm may, however, change from one policy to another.
Apart from critical illness coverage, if an individual needs to undergo an organ transplantation process, health insurance will also cover the same. Some of the different types of organ transplantation expenses are compatibility test expenses, pre-and post-hospitalization expenses, surgery expenses, post-surgery care & recovery and rectification of post-surgery complications (if any).
When policyholders undergo treatments even when they are at home, it is considered as a domiciliary treatment. A health insurance plan will provide coverage for any expenses incurred during the domiciliary treatment. However, you should know that not every health insurance plan covers such treatments taken at home, which means it is not a default cover. Some plans also demand you to pay an additional premium to enjoy coverage against domiciliary treatment.
During the period of an individual’s hospitalization, various additional expenses are not covered under health insurance. With the help of the Daily cash benefit facility provided by a few plans, individuals can take care of such expenses that they might face during the hospitalization. With this, a plan will provide a fixed amount per day during each day of the hospitalization.
When individuals need to be transported to the nearest hospital via ambulance, a health insurance plan also provides coverage against the expenses incurred towards such transportation. Also, you will get the coverage a limited number of times in a policy year that may change from one policy to another.
Health insurance plans also provide coverage against expenses incurred towards maternity and newborn child with a certain waiting period that changes from one policy to another. Some plans also provide coverage for newborn birth defects. You can also choose from different plans made especially for maternity and newborn expenses and have a waiting period as low as 9 months.
During your in-patient hospitalization of 24 hours or more, your policy will also provide coverage against different miscellaneous expenses such as doctor’s consultation fees, room rent charges, surgery fees, nursing fees, ECG, MRI, Blood, Oxygen, X-ray, medicines, etc. Do remember that this converge will be given up to a certain limit on the sum insured that you should check closely before choosing the policy.
A health insurance plan also provides coverage against the expenses incurred on period health check-ups every year. Apart from this, some plans also require individuals to undergo a pre-acceptance medical check-up. In this case too, your health insurance plan provides coverage for expenses up to a certain limit.
So, these are all the things that are covered in health insurance. You should choose a plan with maximum coverage so that you can enjoy your life without any worry. Also, go through your policy brochure to understand the exact coverage of your policy, and then only, finalize it.
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