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What do Health Insurance Plans Cover?

Health insurance provides financial cover against any medical or surgical expenses you incur. Such plans reimburse the medical expenses arising from illnesses or accidents. For treatments in hospitals having tie-ups with the insurer, the providers directly

  • Jan 13, 2021

Health insurance provides financial cover against any medical or surgical expenses you incur. Such plans reimburse the medical expenses arising from illnesses or accidents. For treatments in hospitals having tie-ups with the insurer, the providers directly pay the hospitals.

With the rising cost of medical facilities, investing in a health insurance plan for yourself and your family is imperative. It can help you save a lot of money in case of a medical emergency.

Read on to understand the importance of buying the right health insurance policy, and the extent of coverage your plan can provide.

The extent of health insurance coverage provided in India

The coverage mostly depends on the type of health insurance you choose. Mentioned below are the types of health insurance plans available in India and their offerings to you.

  • Individual health insurance plan: These plans pay the hospitalisation and medical costs of the insured individual. The limit of insurance is pre-decided, and the plans usually do not pay any cash benefits. The policies often feature add-on covers with a minimal rise in the premiums. Such benefits extend the scope of coverage.
  • Family floater health insurance plan: Family floater plans provide health cover to the entire family against a single, consolidated premium amount.
    The best feature of a family floater is that it provides equal health insurance to all the family members. However, during the policy tenure, if a single family-member needs a large sum for their treatment, they can use the entire sum assured. This allows access to a more extensive insurance cover by the family while paying a lower premium price.
  • Pre-existing disease cover plan: Some health insurance plans offer financial covers for pre-existing diseases (PEDs). PEDs are health conditions you may be suffering from, for up to 48 months before buying the insurance.
    These health insurance plans include waiting periods of two to four years before you can raise claims for PED-related expenses. If you want coverage for PEDs, choose a plan with a shorter waiting period.
  • Senior citizen health insurance plan: These health insurance plans cover the health care needs of individuals between 60 to 75 years of age. The policies cover daycare expenses, various age-related diseases, and cashless hospitalisations for an elderly person’s convenience.
  • Critical illness plan: With lifestyle diseases on the rise, investing in a critical illness plan can be a smart financial decision. Treatments for these ailments can be long and expensive. These policies remove the financial burden for quality medical care needed for such health issues.
    Some of the diseases covered under these plans include cancer, cardiac arrest, organ transplant, and stroke.

Investing in the right health insurance policy

Selecting the right insurance policy is essential to get timely financial assistance in medical exigencies. The following guidelines can help:

  • Assess the coverage and nature of all the policies offered by your health insurance provider. Select the one that best suits your specific requirements.
  • Find out the pre-existing diseases and critical illnesses the plan covers and the associated stipulations.
  • Read the policy document carefully to understand all the terms and conditions. Pay special attention to waiting periods and the network of hospitals included.


Clarity about what your health insurance covers, or doesn’t cover, helps you get the maximum advantage from your policy. However, you need to select your plan carefully to ensure your healthcare needs are fulfilled effectively. Kotak Health Shield offers you one of the most reliable health insurance coverages. Along with financial cover against common critical illnesses and pre-existing diseases, it also provides payouts in case of accidental death or disability. Thus, with this single policy, you can cover the expenses for various medical emergencies.

Kotak e-Term Plan

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  • Nominal Cost
  • Multiple Plan Options
  • Flexible Payout Options
  • Critical Illness Rider
  • Tax Savings
  • Long term Coverage

Ref. No. KLI/22-23/E-BB/492


- A Consumer Education Initiative series by Kotak Life

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