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Insurance Expert - Answered on Jul 05, 2022

Sanjib Jha is the CEO of Coverfox Insurance. His expertise includes health and auto insurance. He has over 22 years of experience in the financial sector. He has completed his post-graduation from the Institute of Company Secretaries of India.... more

Question by FAQ on Jul 05, 2022Hindi

1. What all is covered in a comprehensive health insurance policy?

Ans:

Health insurance is a safety net for the financial well-being of an individual or a family. With medical inflation close to 15 per cent year on year, it has become imperative to opt for a comprehensive health insurance plan for the entire family so that the hospitalisation expenses are taken care of.

A comprehensive health insurance plan is an indemnity plan and hence pays for all expenses incurred during hospitalisation. It typically covers all hospitalisation expenses related to an illness, injury or an accident.

So, from the time of hospitalisation, the cost of an ambulance, room rent, medicines, diagnostic tests, surgery/ implant or any other treatment procedures, etc. would be covered under in-patient hospitalisation. Additionally, pre- and post-hospitalisation expenses for diagnosis and follow up treatments, AYUSH treatment, domiciliary, organ donation, etc. treatments and procedures are usually included.

There are other value-added benefits of comprehensive health insurance plans as well; such as free annual medical check-ups, sum insured restoration benefits, maternity and other covers. You can further enhance the base coverage by purchasing optional add-ons like personal accident and critical illness coverage.

DISCLAIMER: The content of this post by the expert is the personal view of the rediffGURU. Users are advised to pursue the information provided by the rediffGURU only as a source of information to be as a point of reference and to rely on their own judgement when making a decision.

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4. What are the most common exclusions in a health plan?

Ans:

Certain conditions are not covered by health insurance policies. These conditions will land in an ‘Exclusion' in your health insurance policy.

The exclusion list includes unless specifically mentioned in your policy document:

1. Pre-existing health conditions which are not declared from the time of policy inception

2. Lifestyle-related conditions

3. Maternity related complications, including treatments and childbirth, etc,

4. Cosmetic Treatments unless necessary for survival

5. Suicide Attempt Injuries

6. Congenital Diseases

7. War Injuries

8. Dental and eye expenses, unless specifically covered under OPD

9. Diagnostic tests without any proper line of treatment which needs hospitalisation

10. Therapies such as naturopathy, magnetic or acupressure, etc.

11. Waiting Period Illnesses

The insurance provider will not accept any claims in these instances. However, you can purchase add-on coverage to include any exclusion to your base coverage.

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