What Expenses Do Health Insurance Plans Cover?

What Expenses Do Health Insurance Plans Cover?

Depending on your insurance provider and the plan selected, you can be covered for a variety of expenses related to medical care, surgeries and treatments. Given below are some of the major expenses covered under health insurance plans.

AYUSH Treatment:

Alternative medicine has always held an important place in the field of medicine. In India, many people turn to alternative methods quite often. AYUSH stands for Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy. Health insurance providers have understood the need to cover such treatments and offer coverage to those who opt for it.

Second Opinions:

Expenses incurred in getting a second opinion may be covered under your plan. This greatly depends on the insurer and the type of plan you have selected. Second opinions are very much necessary when getting treated as they provide either confirmation of the illnesses or question whether the treatment is unnecessary. In some cases, the insurance provider will arrange for a second opinion from their own panel of medical practitioners.

Hospital Cash:

When you are hospitalised, there will be day-to-day expenses that need to be met for yourself and for your caretaker. These expenses include food, toiletries, and anything that might be required for your hospital stay. Insurance plans provide hospital cash as an inbuilt feature or a rider plan. The insurer will provide a set amount of money per day of admission in the ICU and the hospital to help meet these expenses and compensate for the loss of income during this period.

Emergency Evacuation:

In case of emergencies, if the patient needs to be transported to another hospital, the insurance plan will cover the costs associated with shifting hospitals in order to get the suitable treatment.

Organ Donor Costs:

Medical expenses incurred by organ donors might be covered under insurance plans. This means that if someone is donating an organ to you, their expenses will be covered under your health insurance plan.

Domiciliary Hospitalisation:

Any treatments taken at home that exceeds a period of 3 days will be covered.

Ambulance Cover:

The health insurance plans usually cover up to a certain sum for the ambulance service.

Inpatient Care:

These include expenses incurred during hospitalisation for at least 24 hours. Expenses covered include room charges, ICU charges, operation theatre charges, surgeon’s fee, doctor’s fee, anaesthesia, oxygen, blood and so on.

Pre-hospitalisation Expenses:

Any medical expenses incurred for usually 30 days to 60 days before hospitalisation will be covered. These expenses can include diagnostic tests, reports, prescribed medication, investigative tests, et cetera.

Post-hospitalisation Expenses:

Any medical expenses incurred for usually 30 days to 180 days after hospitalisation will be covered. These expenses can include follow-up visits with the doctor, additional diagnostic tests, reports, prescribed medication, et cetera.

Day Care Procedures:

Day care procedures include chemotherapy, dialysis, appendectomy, angiography, colonoscopy, radiotherapy, hydrocele, lithotripsy, eye surgery, piles or fistula, prostate, sinusitis, liver aspiration, sclerotherapy. Insurance plans can cover anywhere between 70 to 400 day care treatments. Some high-end policies may cover every single day care procedure.

Health Check-up:

General health check-ups might be covered under health insurance plans depending on the insurance provider. Preventive health check-ups are encouraged to catch illnesses at early stages so that it can be treated with minimal expenses.


Some plans cover vaccinations required in case of dog bites, bee stings, etc.

Critical Illnesses:

Treatment of critical illnesses can be exorbitant. The coverage of these illnesses might be inbuilt in the base plan or can be added as a rider option. Critical illnesses include heart attack, stroke, multiple sclerosis, blindness, AIDS, coronary artery disease, cancer, viral hepatitis, major organ transplant, paralysis, major burns, coma, terminal illness, motor neurone disease, loss of speech, loss of hearing, Parkinson’s, encephalitis, meningitis, chronic lung disease, chronic liver disease, etc.

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