Scope of cover

When buying a health insurance policy know what you are covered for and what you are not

  • Scope of cover

By OLM Desk

Rising healthcare costs and increasing longevity has created awareness about the importance of health insurance. At a very rudimentary level, health insurance is an insurance, which covers for the medical expenses incurred by you. Similar to other forms of insurance, you can take a policy under which a fixed sum is covered to protect yourself against stated healthcare risks as mentioned in the policy. There is a cost by way of premiums that you pay for such a policy, which depends on your age, current health condition and the amount of insurance that you take, which is the sum assured by the policy.

Like every other insurance policy, health plans too come with conditions. Usually, to avail of any benefits under the health insurance policy, the policyholder needs to be hospitalised for at least 24 hours. The policy typically covers for room or boarding expenses, nursing expenses, surgeon fee, physician, operation theatre charges, medicines, medical tests and a lot many other necessary expenses. Depending on the kind of policy purchased it might also cover pre and post hospitalisation expenses and further help you with certain amount of daily cash allowance during hospitalization under ‘Hospital Cash’ benefit.

In fact, most policies even have a waiting before certain medical conditions are covered by them, also known as pre-existing diseases. Treatment related to preexisting diseases is usually excluded for a fixed period or waiting period, which could be from two to four years depending on the policy type. As with every insurance plan, there are exclusions when it comes to health insurance, which you need to know of. For instance, pregnancy is not covered by most health insurance plans. Among the exclusions that distinctly stand out include dental treatment and prescription glasses in case of defect in eyesight.

Another important exclusion is Sexually Transmitted Disease (STD). Treatment cost for such infections are usually excluded under the permanent exclusions part of the health insurance policy. For you to benefit the most from your health insurance plan, it is recommended you know what your policy covers and what is excluded.