Health insurance is no longer optional in today’s world. Medical costs in India are rising every year. A sudden illness or accident can disturb your savings and financial plans. This is where health insurance plays a vital role.
Many people buy a health insurance policy but are unsure about what it actually covers. This lack of clarity often leads to claim issues or wrong policy choices.
In simple words, health insurance pays for your medical expenses during illness, injury, or hospitalisation. It reduces your financial burden and ensures timely treatment. In this article, we explain health insurance coverage, inclusions, exclusions, and add-on benefits in clear terms.
What Is Health Insurance?
Health insurance is an agreement between you and the insurance company. You pay a premium, and the insurer covers your eligible medical expenses as per policy terms.
The policy can cover an individual or the entire family under a family floater plan.
Core Coverage of Health Insurance
Health insurance mainly covers hospital-related medical costs.
1. Hospitalisation Expenses
This is the most important coverage under health insurance.
It includes:
- Room rent
- ICU charges
- Doctor consultation fees
- Nursing expenses
- Medicines and drugs
Most policies cover hospitalisation expenses if admission lasts more than 24 hours.
2. Pre-Hospitalisation and Post-Hospitalisation
Health insurance also covers expenses incurred before and after hospitalisation.
This includes:
- Diagnostic tests
- Doctor consultations
- Follow-up medicines
Coverage usually applies for 30 to 60 days before and 60 to 180 days after hospitalisation.
3. Daycare Treatments
Modern medical procedures do not always require 24-hour hospitalisation.
Daycare treatments covered include:
- Cataract surgery
- Dialysis
- Chemotherapy
- Angiography
Most health insurance plans cover 100+ daycare procedures.
4. Ambulance Charges
Health insurance covers ambulance expenses during emergencies, up to a specified limit.
Some policies also cover air ambulance charges as an add-on benefit.
Types of Health Insurance and Their Coverage
Different health insurance plans offer different coverage.
1. Individual Health Insurance
This plan covers one person.
It includes:
- Hospitalisation expenses
- Daycare procedures
- Pre and post-hospitalisation costs
It is suitable for individuals without dependents.
2. Family Floater Health Insurance
A family floater plan covers multiple family members under one sum insured.
It covers:
- Self
- Spouse
- Children
- Sometimes parents
This plan is cost-effective for young families.
3. Senior Citizen Health Insurance
Designed for people aged 60 years and above.
It covers:
- Age-related illnesses
- Higher hospitalisation needs
- Regular medical check-ups
Premiums are higher due to increased health risks.
4. Critical Illness Insurance
This plan pays a lump sum on diagnosis of serious diseases like:
- Cancer
- Heart attack
- Stroke
- Kidney failure
The payout can be used for treatment or income loss.
Additional Riders and Add-On Coverage
You can improve your policy coverage with add-ons.
Common health insurance riders include:
- Room Rent Waiver - Removes room rent limits
- Critical Illness Rider - Extra cover for major diseases
- Maternity Cover - Covers delivery and newborn expenses
- OPD Cover - Covers outpatient consultations
These add-ons provide better financial protection.
What Health Insurance Does Not Cover
Health insurance policies also have exclusions.
Common exclusions include:
- Pre-existing diseases during waiting period
- Cosmetic treatments
- Dental treatments unless due to accident
- Self-inflicted injuries
- Alternative therapies unless specified
Always check the waiting period and exclusions section carefully.
Tax Benefits of Health Insurance
Health insurance also offers tax savings.
- Premiums qualify for deduction under Section 80D
- Additional deduction for parents’ health insurance
- Higher limits for senior citizens
This helps reduce your tax burden while staying insured.
How Much Health Insurance Coverage Do You Need?
Your health insurance coverage should match your lifestyle and city.
Consider:
- Rising medical costs
- Family size
- City of residence
- Existing health conditions
For metro cities, experts suggest a minimum cover of ₹10 to ₹15 lakh for a family.
Final Thoughts
Health insurance protects both your health and your finances. It ensures access to quality treatment without worrying about hospital bills. The right policy covers hospitalisation, treatments, and emergencies while offering tax benefits.
Before buying, understand the coverage, exclusions, waiting periods, and add-ons. Choose a plan that suits your family needs and budget. A good health insurance policy is an investment in peace of mind and long-term security.