Does health insurance cover these common things that are massively searched?

Your health insurance policy is not just a document that is to be deposited in your drawer. Skim through your health insurance plan document and chances are you would come across a clause that you never knew about.

The next thing you would do is an online search to find out if a particular healthcare expense is covered in your health insurance plan. There are many lesser-known expenses that are covered by health insurance but you may not know about it.

Let’s look at some of these:

• Pharmacy bills
• Dental treatments and surgeries
• Alternative treatments
• Cosmetic treatments
• Surgeries
• COVID-19
• Maternity

Related blog: A Guide to How Health Insurance Works

Pharmacy bills

There’s no question that medicine bills are one of the most common and biggest expenses–especially when one has a large family with elderly members. Most people think medicine bills aren’t covered by insurance. Many health insurance plans include OPD coverage, which may include coverage for pharmacy bills. Here are some plans that do:

• Apollo Munich Maxima
• Max Bupa Heartbeat Health Insurance Plan

Dental treatments and surgeries

Few insurance companies in India offer dental insurance. Coverage for dental treatments is most often limited to the ones required in the event of accidental treatments and injuries. Insurers do not provide exclusive dental insurance. Insurance plans with OPD coverage provide coverage for dental treatments.

Alternative medicine and treatments

A few years back, insurance companies don’t cover anything more than allopathy. The reasons being alternative treatments were not considered mainstream, treatment costs vary widely depending on the practitioner and hence cost verification was difficult, and a number of patients combine allopathic and alternative treatments.

However, with the rising trend of alternative medicine, insurers started providing coverage for AYUSH – Ayurveda, Yoga, Unani, Siddha and Homeopathy. Here are some health insurance plans that cover alternative medicine.

HDFC Ergo Suraksha Health Insurance Plan covers up to 10 to 20% of the sum insured for alternative treatments.

Star Health Medi Classic Insurance Plan covers alternative treatments up to 25% of the sum insured for alternative treatments. 

Cosmetic treatments

Typically, health insurance plans do not cover plastic surgery, unless it is “essential” or required to support other medical treatments and surgery. For e.g., surgeries such as nose job, breast reduction, facial enhancement, sex change, are not covered by health insurance.

If these surgeries are essential or required in cases of accidents, cancer, post-burn cases, then insurance companies may cover them. However, each insurance company may follow a different guideline and have different clauses. It is best to look at each policy to get the right answer to this question.

All types of surgeries

The kind of surgeries that are covered by a particular health insurance depends on the inclusion clauses of the policy. All types of surgeries may not be covered by all insurance plans. 

Here’s a list of some surgeries that are covered by different insurance plans.

•     Certain surgeries related to the ear – stapedotomy, surgeries of the auditory ossicles, and reconstruction of the middle ear, among others.
•     Certain surgeries related to the nose – sinus, nasal concha, foreign body removal, among others.
•     Surgical treatments for eyes – cataract, corneal incision, eyelid incision, removal of foreign body, among others.
•     Neurological surgery
•     Oncology
•     Chemotherapy

Alongside, let’s also look at surgeries and procedures that are not included in health insurance plans.

•     Cosmetic surgeries
•     Dental surgeries
•     Non-essential surgeries
•     Experimental surgeries

There are even more surgeries covered by health insurance. View the infographic to know more.

Treatments taken at home

Another word for treatments taken at home is domiciliary expenses. When doctor’s advise or under specific circumstances, patients take treatments at home, the expenses for such treatment is called domiciliary expense. 

Many policies cover domiciliary expenses, but oftentimes policyholders are not aware of such a facility. It should be noted that insurance policies may have a sub-limit for domiciliary expenses. E.g. Max Bupa’s Silver Plan has a sub-limit of Rs 15000, Gold Plan has a sub-limit of Rs 50,000 and Platinum Plan has a sub-limit of Rs 2,50,000.  

Coronavirus

Most health insurance plans that cover hospitalization costs would cover coronavirus related medical expenses. However, some policies may have clauses that do not allow coverage for pandemics. 

To understand the effects of COVID-19 on health insurance in India, let’s take a look at the clauses and guidelines set by the Insurance Regulatory and Development Authority of India (IRDAI).

• The IRDIA has allowed insurers to offer short-term health insurance policies of up to 3 months to 12 months to cover coronavirus. These can be individual or family floater plans. 
• According to experts, these short-term coronavirus health insurance policies are good for those who do not have any health insurance; while for others, a COVID-19 plan could be a good top-up to their existing health plan.
• Insurance plans that include hospitalisation coverage to expedite COVID-19 related cases.
• The cost of medical expenses including that during the quarantine period should be settled as per the policy terms.
• The IRDAI has asked insurance companies to design specific products to meet the needs of coronavirus related medical care.
• The IRDAI has advised insurers to thoroughly review claims made for COVID-19 related medical treatments to avoid rejections.

Maternity

Maternity health insurance can be beneficial to those couples who are planning to start a family. However, it should be noted that most insurers have a waiting period of at least 2 to 4 years for maternity insurance to be applicable. Now if one is already pregnant, buying maternity insurance would be useless.

Maternity insurance also has certain clauses and limits. Limit to the number of children, sub-limits on sum insured, and other clauses, which may not make maternity insurance as beneficial as desired.

E.g. if the sub-limit for maternity is Rs 20,000, it would hardly cover maternity expenses in a good hospital in a city. Although, the bright side is that it can provide a cushion. Moreover, maternity insurance also provides coverage for newborn babies from the time of birth.

Over to you

Still have questions about some expenses included or excluded in your health insurance plan? Or are you looking to purchase a health plan based on coverage provided by different plans? Let us know and we’ll help you with all you need to know.