10 Vital Aspects: What Does Health Insurance Cover?



10 Vital Aspects: What Does Health Insurance Cover?



Health insurance is more than just a safety net; it’s a lifeline in turbulent times. With soaring medical expenses, it has become a necessity rather than a luxury. But have you ever paused and asked, “What does health insurance cover?” Let’s embark on this enlightening journey to explore the layers beneath this seemingly straightforward question.

Why do I need health insurance?

There are many reasons why you need health insurance, especially in India where the cost of medical care is rising steadily. Here are some of the most important reasons:

  • To protect yourself from financial ruin. The cost of medical care can be staggering, even for a minor illness or injury. Without health insurance, you could be responsible for paying for all of your medical expenses out of pocket. This could easily bankrupt you, even if you have a good income.
  • To get the care you need when you need it. Health insurance can help you get the care you need, when you need it, without having to worry about how you’re going to pay for it. This is especially important for people with chronic conditions or who need regular medical care.
  • To cover preventive care. Preventive care, such as annual checkups and vaccinations, can help you stay healthy and avoid more serious health problems. Health insurance often covers preventive care at no cost to you.
  • To save money on taxes. In India, you can claim a tax deduction for the premiums you pay for health insurance. This can save you hundreds or even thousands of rupees each year.
  • To protect your family. If you have dependents, such as children or elderly parents, you need to make sure they have health insurance too. Health insurance can help you protect them from financial hardship if they get sick or injured.

Overall, health insurance is an essential financial protection for everyone. It can help you afford the care you need, stay healthy, and save money on taxes. If you don’t have health insurance, I urge you to consider getting it. There are many affordable plans available, and the peace of mind it provides is priceless.

Here are some additional things to keep in mind when choosing a health insurance plan in India:

  • The coverage limits: Make sure the plan you choose has enough coverage to meet your needs.
  • The deductible and copays: These are the amounts you will have to pay out of pocket before the insurance company starts paying.
  • The network of doctors and hospitals: Make sure the plan you choose has a network of doctors and hospitals that you’re comfortable with.
  • The waiting periods: Some plans have waiting periods for certain types of coverage, such as maternity care.
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What Health Insurance Really Covers

Health insurance typically covers medical expenses incurred due to illnesses, injuries, or medical conditions. Policies may vary, but there are some common grounds which they cover. Below are the details:

  1. Hospitalization: This includes room rent, nursing charges, ICU charges, surgeon’s fees, and other related charges.
  2. Pre and Post Hospitalization: These are costs incurred before being hospitalized and after discharge, like diagnostic tests.
  3. Daycare Procedures: Some surgeries don’t need a 24-hour hospitalization, like cataract surgery.
  4. Ambulance Charges: In emergencies, ambulance charges can be covered to a certain limit.
  5. Domiciliary Treatment: When treatment is taken at home due to lack of bed space in the hospital or the patient’s severe condition.
  6. AYUSH Treatment: Many insurance companies cover treatments under Ayurveda, Yoga, Unani, Siddha, and Homeopathy.

Understanding the Types of Health Coverage

  • Primary Care: Routine check-ups, vaccinations, or minor illnesses fall under primary care.
  • Specialist Services: For specific issues, you might need a specialist. Insurance often covers these, albeit sometimes with a referral.
  • Prescription Drugs: Not all medications are covered, but most essential drugs generally are.
  • Emergency Services: Hospital trips in emergencies, like heart attacks, are crucial.
  • Maternity and Newborn Care: Coverage from pregnancy to childbirth and postnatal care.

Things Typically Not Covered by Health Insurance

While health insurance covers a lot, it doesn’t cover everything under the sun. Here are common exclusions:

  • Cosmetic surgeries: Procedures like nose jobs aren’t usually covered unless medically necessary.
  • Alternative therapies: Acupuncture or other non-traditional treatments might be out of the scope for some plans.
  • Over-the-counter drugs: Medications that don’t require a prescription.

Benefits of Comprehensive Health Coverage

Having extensive coverage ensures:

  • Financial Security: Guarding against hefty medical bills.
  • Peace of Mind: Knowing you’re protected in health crises.
  • Access to Quality Care: Better care options available.

Choosing the Right Plan for You

The trick isn’t just about getting insured; it’s about getting the right plan.

  • Evaluate Needs: Consider your medical history and potential future needs.
  • Review Network: Check if your preferred doctors and hospitals are in-network.
  • Compare Premiums and Benefits: Look beyond just the monthly cost.

What is a premium?

The term “premium” has multiple meanings, depending on the context. In general, it refers to a price that is higher than the usual or standard price.

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In insurance, a premium is the amount of money that an insured person or entity pays to an insurance company to cover the cost of potential losses. The premium is calculated based on a number of factors, including the type of insurance, the insured person’s or entity’s age, health, and lifestyle, and the likelihood of a loss occurring.

In other contexts, a premium can also refer to:

  • A higher-quality product or service that is sold at a higher price.
  • A reward or bonus that is given for something, such as a loyalty program or a contest.
  • A financial instrument that pays a higher interest rate than a regular bond.
  • A fee that is paid to borrow money, such as a mortgage premium.

In general, a premium is a price that is paid for something that is considered to be of higher value or quality.

Here are some specific examples of premiums:

  • Health insurance premium: The amount of money that a person pays to an insurance company to cover the cost of medical expenses.
  • Car insurance premium: The amount of money that a person pays to an insurance company to cover the cost of damage to their car if they are in an accident.
  • Home insurance premium: The amount of money that a person pays to an insurance company to cover the cost of damage to their home if it is damaged by fire, theft, or other events.
  • Life insurance premium: The amount of money that a person pays to an insurance company to cover the cost of paying a death benefit to their beneficiaries if they die.
  • Premium bonds: A type of government-backed investment that pays a higher interest rate than regular bonds.
  • Mortgage premium: A fee that is paid to the lender when taking out a mortgage.

How do I choose the best health insurance plan for me?

Here are some factors to consider when choosing the best health insurance plan for you:

  • Your budget: How much can you afford to pay in monthly premiums and out-of-pocket costs?
  • Your health needs: Do you have any pre-existing conditions? How often do you go to the doctor?
  • Your lifestyle: Do you have a family? Do you travel frequently?
  • Your employer: If you have employer-sponsored health insurance, your options may be limited.
  • The type of plan: There are four main types of health insurance plans: HMO, PPO, POS, and EPO. Each type has its own pros and cons.

Once you’ve considered these factors, you can start comparing health insurance plans. Here are some resources to help you:

  • This website is a good place to start your search for health insurance plans. You can compare plans based on your budget, health needs, and location.
  • Your state’s health insurance marketplace: Each state has its own health insurance marketplace. You can find information about plans available in your state on this website.
  • A health insurance broker: A broker can help you compare plans and find the one that’s right for you.
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Here are some additional tips for choosing a health insurance plan:

  • Read the plan’s summary of benefits: This document will explain all of the plan’s coverages, costs, and limitations.
  • Make sure your doctors are in network: If you have a regular doctor, make sure they’re in the network of the plan you’re considering.
  • Consider your deductible and copays: These are the amounts you’ll have to pay for covered services before your insurance starts to pay.
  • Look for a plan with a good customer service reputation: If you have any problems with your plan, you’ll want to be able to get help easily.

Choosing a health insurance plan can be a daunting task, but it’s important to do your research and choose the plan that’s right for you. By following these tips, you can find a plan that meets your needs and budget


How often should I review my health insurance plan? It’s wise to review your health insurance annually, especially during open enrollment, or when you experience significant life changes.

Are pre-existing conditions covered? Many plans now cover pre-existing conditions, but it’s essential to check the policy’s fine print.

Can I get health insurance even if I’m unemployed? Absolutely! You can consider COBRA, state insurance programs, or marketplace insurance plans.

What’s the difference between HMO and PPO? HMO requires you to choose a primary care physician and get referrals for specialists. PPO offers more flexibility in choosing doctors without referrals.

Is mental health covered under health insurance? Yes, most modern policies cover mental health services akin to physical health services.

Do health insurance plans cover COVID-19 treatments? Many health insurance providers have extended their services to cover COVID-19 related treatments. However, it’s always best to check with your insurer.


The world of health insurance can be complex and confusing, but understanding its scope is critical. “What does health insurance cover?” is not just a query, but a pathway to peace of mind. When armed with the right knowledge, you can navigate this maze with confidence and secure the best possible care for yourself and your loved one.


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