What Does Health Insurance Typically Cover? Key Inclusions You Must Know

What are Inclusions Under Health Insurance?

Inclusions under health insurance are services that your insurance provider promises to cover through a claim settlement process. When you purchase a health insurance policy, it includes certain coverages, such as hospitalisation, pre- and post-hospitalisation, ambulance cover, doctor consultation charges, etc., whose costs are covered by the insurance company.

Understanding these inclusions before purchasing the policy is crucial to ensuring your health plan aligns with your medical needs.

Inclusions That You Must Look Out For

Usually, health insurance policies have a different set of inclusions and exclusions; however, here are some common inclusions that you must look for while purchasing a health plan to ensure adequate hospital insurance cover:

In-Patient Hospitalisation

Any hospitalisation lasting at least 24 hours is considered inpatient hospitalisation. Usually, all health insurance policies cover inpatient hospitalisation expenses. This can include expenses incurred for hospitalisation, intensive care unit (ICU) treatment, medical and drug costs, nursing care, diagnostic tests, doctor’s fees, and more.

Pre and Post Hospitalisation

In cases involving specific treatments or surgeries, several pre- and post-hospitalisation expenses are also involved. Ensure you pick a policy that covers such expenses.

Know that, typically, insurance companies offer coverage for:

• Pre-hospitalisation expenses up to 30 to 90 days,
• Post-hospitalisation expenses up to 62 and 80 days.

Day Care Treatments

With advancements in medical science, several treatments can now be performed within 24 hours, and you are free to go home the same day. Such treatments are called day care treatments, like chemotherapy, cataract surgery, dialysis, radiotherapy, etc. The expenses incurred for such treatments are usually high; therefore, reliable health insurance must include coverage for them.

Preventive Health Check-Ups

Preventive health check-ups are one of the most reliable ways to ensure timely treatment and prevent a condition from becoming severe. These checkups can include various types of tests such as renal function, ECG, blood sugar, blood pressure, etc.

To ensure that you do not step back from taking preventive health check-ups, insurance companies usually cover these check-ups.

Domiciliary Treatment

Under conditions where hospital beds are not available, or the treatment is for specific medical conditions, treatments are provided at home. Such treatments are known as domiciliary treatment. Being treated at home does not prevent you from getting coverage under your health plan. Ensure that your policy offers coverage for domiciliary treatment.

AYUSH Treatment

AYUSH treatment stands for Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy. Many health insurance policies offer coverage for AYUSH treatment as well. However, remember that these policies offer coverage only when such treatments are taken at a government hospital or an authorised AYUSH treatment Centre.

Ambulance Expenses

Coverage for Ambulance expenses is a common feature in most health insurance policies. This coverage allows you to get quick access to medical assistance during medical emergencies.

Pro Tip: You can also look for health insurance policies that offer coverage for Air Ambulance.

Modern Treatment

As the medical world is moving towards modern treatment, health insurance policies ensure that you can have easy access to such treatments by offering you modern treatment coverage. These treatments usually include intravitreal injections, robotic surgeries, deep-brain stimulation, stem cell therapy, immunotherapy, etc.

Did you know that the Insurance Regulatory and Development Authority of India has mandated the coverage of 12 modern treatments in health insurance policies?

Mental Health Care

Mental health concerns should no longer be taboo in India. To take a step towards this, the Insurance Regulatory and Development Authority of India has mandated that all health insurance companies provide mental illness coverage in the base plan. Usually these policies offer coverage for treatments or therapy for anxiety, stress disorder, sleeping and eating disorders, dementia, bipolar disorders, acute depression, etc.

Second Medical Opinion

In cases of critical illness or surgery, you might need to consult another specialist for a second opinion. Although such coverage is usually available under specific health plans, it is a coverage you must look for if you are still exploring health plans.

Pro Tip: Head to Jio Insurance Broking to explore plans and choose one that offers adequate, comprehensive coverage.

Maternity Benefits

Maternity benefit is an important coverage offered under many health insurance policies. If you are planning to start a family, it is best advised to look for a policy with such benefits at an early stage. Why? Maternity benefits under health plans usually come with a waiting period during which you can not raise any claims.

You can expect coverage for normal and cesarean delivery, prenatal and postnatal costs, newborn baby expenses, and a lot more.

Final Words

Whether you are someone looking for a new plan or renewing your existing health insurance, it is crucial to check the inclusions thoroughly. Additionally, do not skip the exclusion list and claim settlement process for a hassle-free experience with your health insurance in future. Jio Insurance Broking is determined to bring the best health plans under the same platform for you to easily explore, compare and purchase.

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