Which diseases are covered under health insurance?

Which diseases are covered under health insurance? Well, basically, all diseases are covered under health insurance, however to get cover for all diseases there is some waiting period for some diseases. For example, there are some diseases like Arthritis, Spinal cord issues (Unless caused by accident) etc, which have a waiting period of 2 years, and all preexisting diseases have waiting period of 3–4 years.

Which diseases are covered under health insurance?

Primarily, there are 3 different types of Health Insurance cover

  1. Individual Mediclaim
  2. Family Floater Policy
  3. Unit Linked Health Plans

Health insurance is a broad term, so the answer depends on whether the policy is comprehensive major medical or a limited coverage policy. I suggest you read the material on this link: Health insurance that counts as coverage  (under the Affordable Care Act)

If compliant with the Affordable Care Act, major medical policies issued after 1/1/2014 would cover any illness, whether new or existing. How they are covered, how much your share of costs would be and what facilities you could use for treatment, depends on the policy.

Which diseases are covered under health insurance?
Which diseases are covered under health insurance?

The per person maximum out of (your) pocket costs, including copays, deductible, % of costs after the deductible and before the maximum is met, allowed by any ACA compliant major medical policy is currently $6,850 per year. Generally, the more you pay for a policy, the lower the total out of pocket costs. Look at that carefully, as you may just be paying ahead for costs you might not have, if you buy a policy with lower out of pocket costs.

Some might cost an additional $3,000 per year, for example. If you don’t have many medical bills during the year, you have now freed up $3,000 to put into savings for any emergency, not just medical. ACA compliant plans will also pay for an annual checkup with no deductible. See this link for details:

Preventive health services  You can choose from 3 links on the page for adults, women and children.

As the previous answer mentioned, there are limited coverage plans that may cover only certain illnesses or accidents. These can be a help especially if the major medical plan has high out of pocket costs. So, the answer for the question: Which diseases are covered under health insurance, take a look at below:

What are the diseases not covered under health insurance?

Coverage of diseases under a health insurance policy will differ from policy to policy. Usually, all diseases are covered, except the ones which are mentioned under exclusions. The most common exclusions are:

  • Treatment expenses for disease or injury contracted / sustained directly or indirectly due to war, invasion, foreign enemy acts will not be covered.
  • Cost of eyesight treatment, hearing aids, contact lenses, spectacles.
  • Dental treatment or surgery where no hospitalization is required.
  • Treatment of wilful self-injury and injuries / illnesses caused due to usage of intoxicants.
  • Venereal diseases, any direct/indirect AIDS related treatment, circumcision.
  • Aesthetic enhancing or cosmetic treatment.
  • Intentional termination of pregnancy, pregnancy and childbirth.
  • Naturopathy treatment, Nature Cure & Wellness Clinics.
  • Addictive conditions and disorders and hereditary conditions.
  • Injuries sustained due to participation in adventure or hazardous sports.
  • Ageing, puberty and obesity.
  • Alternative treatment, artificial life maintenance, charges for medical papers.
  • Convalescence and rehabilitation.
  • Drugs, dressing for OPD Treatment or take-home use.
  • Preventive care or reproductive medicine.
  • Treatment received outside India, from an unrecognized hospital/physician, experimental/unproven treatment, cost of diagnosis unrelated to illness/injury

There are a lot of diseases not covered under health insurance as well, some of them are:

  • Infertility
  • Genetic disorders
  • Tobacco use and related complications
  • Cosmetic surgery
  • Cataract
  • Hernia etc.

What does health insurance cover?

If you are still pondering over the benefits of health insurance plans, I can assure you that you will be intrigued to buy health insurance after the end of this post. Based on the type of health cover you choose to buy, you will receive the following coverage for:

Cashless Treatment

If you buy a health insurance policy, you will become eligible for cashless treatments. You can avail of the benefits of cashless hospitalization at any of the various network hospitals your insurer is associated with.

Ambulance Expenses

Another significant benefit of possessing medical insurance is that the policy offers coverage for ambulance expenses incurred on the transportation of insured. This way, it eliminates the need for arranging a vehicle in the event of a health emergency.

Pre & Post-hospitalization Expenses

Health insurance policies offer coverage for pre and post-hospitalization costs for a specific number of days, preferably for 30 and 60 days respectively. However, some insurers offer coverage for more days since it totally depends on the type of plan you are purchasing. ​

No Claim Bonus

Chances are, you have already come across the term No claim bonus or NCB if you have a small idea about insurance policies. NCB for health insurance stands as an award that is paid to the insurer at the time of the policy renewal on condition that he/she has not filed any claim during the previous policy term.

Medical Checkup

When you choose to buy a health cover on the basis of your preferred plan type, you will become eligible for free health checkups. Keep in mind that such health checkups are offered by some insurance providers on the basis of your previous NCBs.

Organ Donor Expenses

A mediclaim policy provides you with the security against any worry of medical expenses that come with the procedure of undergoing an organ transplant surgery. If this feature is not already offered by your basic health insurance plan, it may be offered to you as an add-on cover.

Room Rent

Most providers of insurance policies in India offer coverage for hospital room rent costs on the basis of the premium paid by the insured individual and the Sum Insured amount.

Daily Hospital Cash Allowance

You can consider Daily Hospital Cash Allowance as one of the hidden features of health insurance given that you are offered this benefit under your plan. This feature allows you to take care of your additional expenses such as travel, food and other similar expenses during hospitalization.

Alternative Treatment

Nowadays, a number of health insurance providers offer coverage for alternative treatment like Homeopathic, Ayurveda, Yoga, Unani, and others. On your purchase of a health cover that offers coverage for these alternative treatments, you will be able to make the most of those treatments without having to bear any expenses on your own.

Domiciliary Treatment

This treatment basically means treatment at home. Most of the health insurance plans today cover the costs of domiciliary treatment for availing treatment at home under medical supervision.

There are a lot of diseases covered under the health insurance policy. The list is too big to display here. Which diseases are covered under health insurance:

  • Cancer
  • Heart attack
  • Organ transplant
  • Parkinson’s
  • Alzheimer’s
  • Brain tumour
  • Anaemia etc.

Apart from this, following things are also covered under the health insurance policy

  • Hospitalization expenses
  • Pre, post hospitalization expenses
  • Domiciliary expenses
  • Pre-existing diseases after a definite waiting period
  • Ambulance charges
  • Maternity expenses(optional cover)
  • Prescription drugs
  • Chronic diseases(optional cover)
  • Day care procedures etc.

If you opt for a specific policy like cancer insurance or critical illness or chronic management, you can get a lump sum pay out option as well. Make sure you read all the exclusions before buying a health insurance policy, just to be sure.

Which diseases are covered under health insurance?
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