Introduction
Health insurance is a safety net that helps protect you from unexpected medical expenses. It is an agreement under which the insurance company bears your health-related expenses if you fall ill or require medical services during a certain period. What are the inclusions and exclusions of health insurance, In today’s time, medical expenses are increasing rapidly, and in this situation, the importance of health insurance increases even more.
Health insurance not only provides you with financial security but also gives you peace of mind that you will not have to face a financial crisis in case of any kind of unexpected medical situation.
Need for Health Insurance
- Protection from unexpected medical expenses: In times of critical illnesses or accidents, huge medical bills can badly affect your financial budget. Health insurance covers these unexpected expenses.
- Access to better healthcare services: The insured person can avail good hospitals and medical services.
- Income Tax Exemption: Under Section 80D of the Income Tax Act 1961, you get tax exemption on health insurance premiums.
- Preventive Care: Some health insurance plans also cover preventive health check-ups, so that you can take care of your health from time to time.
Inclusions in Health Insurance
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Various types of expenses are covered under health insurance plans, which are extremely helpful for the insured. Let us know which expenses are covered under health insurance :
1. Hospitalization Expenses
The insurance company covers the expenses incurred during hospitalization, which include doctor’s fees, nursing charges, operation theatre expenses, medicines, and equipment.
2. Pre-Hospitalization and Post-Hospitalization Expenses
Some insurance plans also cover medical expenses before hospitalization and after discharge. This period is usually 30 to 60 days.
3. Day Care Procedures
Insurance plans also cover treatments that can be completed in less than a day in the hospital, such as chemotherapy, dialysis, or surgical procedures.
4. Ambulance Charges
Many insurance plans also cover the cost of ambulance service used in an emergency.
5. Health Checkup
Some insurance plans also cover the cost of preventive health check-ups and annual medical tests.
6. AYUSH Treatment
Many insurance plans also cover treatments of alternative systems of medicine such as Ayurveda, Homeopathy, Unani, and Siddha, allowing you to avail the benefits of naturopathy.
Exclusions in Health Insurance
Health insurance policies have certain conditions and exclusions under which certain services are not covered. You must read these exclusions carefully before buying the policy:
1. Pre-Existing Diseases
Most health insurance plans do not provide coverage for pre-existing diseases for a certain period of time (usually 2-4 years). Only after this period, treatment of these diseases will be covered under insurance.
2. Cosmetic Surgery
Cosmetic or aesthetic surgery, which is performed for physical beauty rather than a medical necessity, is not covered by health insurance.
3. Possible Diseases
There is a period (usually a waiting period of 30-90 days) before critical illness coverage under the policy kicks in, during which illness-related expenses are not insured.
4. Alternative Treatments or Experimental Therapies
Treatments that do not have sufficient medical evidence are not covered in the insurance policy.
5. Suicide and Mental Health Problems
Insurance policies do not cover medical expenses related to suicide or mental health problems unless the policy specifically mentions mental health.
Pros of Health Insurance
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There are many benefits of health insurance, which makes it essential. Let us know about them in detail:
1. Economic Security
The insured does not have to face heavy medical expenses, keeping his financial position secure.
2. Various Options Available
Nowadays, health insurance policies offer various features, such as cashless treatment, better services in in-network hospitals, and coverage of alternative medicine.
3. Tax Benefits
Taking a health insurance policy qualifies for tax exemption under Section 80D of the Income Tax Act, which is an additional financial benefit.
4. Mental Peace
The insured person has the peace of mind that he or she is prepared to deal with sudden medical needs.
Limitations (Cons) of Health Insurance
1. High Premium
The premiums for insurance policies with comprehensive coverage, especially for families or the elderly, can be expensive.
2. Long List of Exclusions
Some health insurance policies have so many excluded services that the insured may not get coverage in many cases.
3. Waiting Period
Many policies have a waiting period before insurance coverage begins, during which the policyholder has to pay out-of-pocket expenses.
Conclusion
Health insurance is a necessity today. It not only covers unexpected medical expenses but also helps you plan for a better and safer future. However, it is important to understand all its inclusions and exclusions thoroughly before buying a policy so that you can choose the right one.
FAQs
1. What things are covered in health insurance?
Health insurance covers the following:
- Cost of Hospitalization (Room Rent, ICU Charges)
- Doctor’s fee and surgery expenses
- Cost of medical equipment and tests
- Cost of operations, treatments, and medicines
- Delivery expenses for pregnant women
- Alternative medicine methods like Ayurveda, Homeopathy, etc. (under certain policies)
- Preventive care and health checkup costs
2. What things are not covered in health insurance?
The following things are usually not covered under health insurance:
- Pre-existing conditions (some policies may have limited coverage)
- Pre and postpartum complications (some policies may have limits)
- Cosmetic Procedures
- Regular health checkups and alternative treatments (may have limited coverage in some policies)
- Forced accidents or suicide
- Treatments that are not done in a hospital (home treatment)
3. What are hospitalization expenses covered under health insurance?
Hospitalization expenses covered under health insurance include:
- Room Rent
- ICU Charges
- Surgery and doctor’s fees
- Medical tests and investigations
- Cost of medicines and treatments
- Post-operative care (Recovery costs)
4. Is the cost of medicines covered by any health insurance?
Yes, most health insurance policies cover the cost of medicines during hospitalization. However, this may vary depending on the policy terms and coverage. Some policies do not cover out-of-pocket medical expenses and medicines.
5. Are pre-existing diseases covered in a health insurance policy?
Pre-existing diseases are generally not covered by health insurance. But some insurance companies offer plans in which pre-existing diseases can be covered after a certain period, say after 2-4 years. This is called the “Waiting Period”.