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What Medical Expenses Can You Claim in Health Insurance Plans?

Health insurance plans typically cover a range of medical expenses, providing comprehensive financial protection for various healthcare needs.

  • 7,845 Views | Updated on: Jan 11, 2024

Health insurance is a vital shield against the uncertainties of medical expenses, providing financial security and peace of mind.

Key takeaways

  • One of the aspects of health insurance coverage is in-patient hospitalization.
  • All medical costs incurred before being hospitalised, up to a pre-specified period, are also covered.
  • The health insurance plans also cover the cost of medications and post-hospitalization care.
  • Health insurance also covers outpatient services, diagnostic tests, and follow-up visits without the need for hospitalization.

By being aware of the nuances of coverage, individuals can ensure that their health insurance provides robust financial protection for various medical needs, promoting physical and financial well-being.

Importance of Health Insurance in Recent Times

Health insurance coverage is a beneficial investment at all times. However, in recent times, it has become more of a necessity than a choice. Essentially, because:

  • The gruesome COVID-19 pandemic has affected more than 9.5 million in the country. Without a good health insurance plan, the treatment cost can create a dent in the pocket, especially when one gets treated at private hospitals.
  • The Indian healthcare sector is aiming to achieve a valuation of USD 132 billion in 2023, demonstrating a Compound Annual Growth Rate (CAGR) of 16-17%.
  • The rising incidence of health risk factors like stress, unhealthy eating, physical inactivity, environmental pollution, etc., have increased the chances of people falling sick. Even the young population is prone to multiple health diseases and ailments today.

Hence, investing in a comprehensive health insurance plan is vital to ensure you are prepared for all types of medical emergencies in the future. However, you must understand the expenses covered by a health insurance plan and its terms and conditions before making an informed decision.

List of Expenses Covered by Health Insurance

Each insurance company offers plans that cover different expenses. Some of the standard health expenses covered are:

In-patient Hospitalization

One of the fundamental aspects of health insurance coverage is in-patient hospitalization. It forms the backbone of health insurance coverage, offering financial protection for major illnesses and surgeries. In-patient hospitalization costs include:

  • Room rent or boarding expenses
  • Nursing expenses
  • ICU charges
  • Doctor consultation
  • Surgery
  • Other costs, like surgical tools, diagnostic material, etc.

Pre-hospitalization expenses

All medical costs incurred before being hospitalized, up to a pre-specified period, are covered in the insurance plan. These include doctor consultations, medical investigations, preliminary procedures, preventive surgeries, diagnostic tests, medicines, etc.

Post-hospitalisation expenses

All costs involved in your care and medicines after you are discharged from the hospital, up to a pre-specified period, are included in your healthcare insurance. These include post-hospitalization consultation, diagnostic tests, medicines, therapy, drugs, etc.

Outpatient Services

Health insurance is evolving to cover outpatient services, providing financial relief for medical consultations, diagnostic tests, and follow-up visits without the need for hospitalization. This feature ensures that individuals can access necessary medical care without worrying about the associated expenses.

Prescription Medications

The cost of prescription medications can be a significant burden, especially for chronic conditions. Health insurance policies often cover the expenses of prescribed drugs, ensuring that individuals can adhere to their treatment plans without sacrificing financial stability.

Maternity Expenses

Many health insurance plans now include coverage for maternity expenses, encompassing pre and post-natal care, delivery, and associated medical procedures. This feature provides crucial financial support during a significant life event, promoting the well-being of both mother and child.

Preventive Care

Preventive care is a cornerstone of overall well-being; health insurance policies recognize its importance. Coverage for preventive services such as vaccinations, health check-ups, and screenings encourages policyholders to manage their health, preventing potential illnesses and complications proactively.

Rehabilitation Services

Recovering from an illness or injury often involves rehabilitation services, such as physiotherapy or occupational therapy. Many health insurance policies include coverage for these services, ensuring that individuals can fully recover without bearing the entire financial burden.

Ambulance Charges

Health insurance policies commonly cover ambulance charges, ensuring emergency transportation to a medical facility is not an additional financial strain. This coverage encompasses ground and air ambulance services, offering peace of mind during critical situations.

Daycare Treatments

Traditionally, health insurance was associated with hospitalization, but modern policies extend coverage to daycare treatments as well. Procedures that require less than 24 hours of hospitalization, such as certain surgeries or diagnostic tests, are often included, broadening the scope of coverage.

Conclusion

Understanding the scope of coverage provided by your health insurance plan is crucial to making informed decisions about your healthcare. While these are common expenses that many insurance plans cover, reviewing your policy’s specific terms and conditions is essential to know exactly what is included. Regularly reviewing your health insurance coverage ensures that you are aware of any changes and can adjust based on your evolving healthcare needs. By staying informed, you can maximize the benefits of your health insurance and effectively manage your medical expenses.

- A Consumer Education Initiative series by Kotak Life

Amit Raje
Written By :
Amit Raje

Amit Raje is an experienced marketer who has worked in various Fintechs and leading Financial companies in India. With focused experience in Digital, Amit has pioneered multiple digital commerce in India. Now, close to two decades later, he is the vice president and head of the D2C business department. He masters the skill of strategic management, also being certified in it from IIMA. He has challenged his challenges and contributed his efforts in this journey of digital transformation.

Amit Raje
Reviewed By :
Prasad Pimple

Prasad Pimple has a decade-long experience in the Life insurance sector and as EVP, Kotak Life heads Digital Business. He is responsible for developing user friendly product journeys, creating consumer awareness and helping consumers in identifying need for life insurance solutions. He has 20+ years of experience in creating and building business verticals across Insurance, Telecom and Banking sectors

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