Health Insurance: Inclusions & exclusions during COVID

Health and wealth go hand in hand! Keeping this proverb in mind, you must secure self and your family members from unexpected situations with an additional source of financial assistance.

Recently, the spread of Covid-19 virus heightened the requirement of a comprehensive health insurance policy to overcome such financial emergencies.

Although people rush to buy a health plan, one hardly pays heed to gain knowledge about it. Researching and learning about the inclusions and exclusions of health insurance policy will only guide you to make a better choice.

Exclusions of Health Insurance Plans

1. Pre-Existing Illnesses

If you suffer from an ailment before buying a health cover, it is considered as a pre- existing illness. Many insurers do not provide coverage for them. Generally, they are excluded from health insurance coverage for an initial waiting period.

Indian Regulatory and Development Authority of India regulates the maximum waiting period for such illnesses for a maximum of 4 years. The time also depends upon the type of ailment and its risk.

 Diseases like cataract, kidney stones, arthritis, few chronic diseases and conventional treatments can be excluded from coverage. You can check it with your insurance provider before buying a health cover.

2. Waiting Clause

Mostly, insurance companies do not offer immediate coverage apart from accidents and unfortunate demise. It also includes diseases which are not excluded from the plan.

Usually, there is a waiting period of 1-2 months only after which you will get the advantages of the scheme.

3. Surgery

Health insurance policy does not cover joint replacement, cosmetic surgery, dental surgery, and others. However, if the surgery treatment arises from any other cause apart from the exclusion mentioned, costs are covered under the plan. You can contact your health insurance provider for all details on surgical treatment.

4. Hospital Costs

The hospital costs can be restricted in the form of sub-limits on room rent, medical examiner fees, transport costs and similar others. It would be wise to check all the exclusions and limits in the policy document to remain prepared for emergency hospital visits.

5. Permanent Exclusions

Some insurers do not offer coverage for permanent exclusions like injuries in war, HIV, and intentional injuries. Make sure you check all the documents to know the details for avoiding any confusion at the time of making policy claims.

Inclusions of Health Insurance Plans

1. Pre and Post Hospitalization Expenses

Mostly, insurers offer coverage for pre and post-hospitalization expenses.

– Pre-Hospitalization Charges: generally includes the expenditure incurred in 30 or 60 days before the date of admission to the hospital

– Post- Hospitalization Charges: typically includes the expenses incurred in 60 or 90 days after discharge from the hospital.

2. No Claim Bonus

Your insurance company will provide additional coverage if you do not make any claim during the policy year. There are two types of claim bonuses:

– Discount on premium: You will receive it as a monetary bonus during the time of health insurance plan renewal.

– Cumulative benefit: Sometimes, insurers offer a yearly increase in the sum insured under the benefit of no claim bonus.

3. Cashless Treatment Facility

Most health insurance companies provide a cashless treatment facility. Under this benefit, you do not have to pay at the hospital for treatment or filing for reimbursement later.

After informing, the expenses will be covered by your insurer and directly settle the bill with the hospital.

4. Maternity Benefit

Many health insurance policies offer coverage for maternity expenses like childbirth, vaccination, and hospitalization costs.

The waiting period varies for different plans ranging from one-two years. It is essential to know that this coverage is only provided if you select the option of pregnancy in your policy.

Inclusion and exclusion make a health insurance policy beneficial for every individual as per their requirement. You should only buy the one suiting your needs from reliable insurers.

Reputable insurance companies like Tata AIG offer health insurance plans with many benefits like Ayush treatment, vaccination coverage, domiciliary, and daycare treatment. You can visit the website and make an informed decision after reading the policy documents thoroughly.