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Does Your Health Insurance Cover the Overall Cost? Research Team | Posted On Tuesday, September 10,2019, 08:19 PM

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Does Your Health Insurance Cover the Overall Cost?



What is health insurance? Why is it important? Does my health insurance cover the overall medical costs? These are the important questions to be answered from the perspective of potential and existing health insurance buyers. It is great if you already have a health insurance policy as it is very much required today. Why is this so?

People are leading a very modern lifestyle today. They are therefore, prone to common lifestyle diseases like obesity, type 2 diabetes, heart problems, cancer, high blood pressure and many others. Such diseases will cost you lakhs of rupees. The point here is that not all people can afford to pay high medical expenses. A health insurance policy helps get rid of unexpected health issues.

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Does Your Health Insurance Cover the Overall Cost?​

Defining Health Insurance

Health insurance serves as a financial guard and pays for the medical expenses if you fall sick. It may be defined as insurance against the unforeseen health care or medical expenses of an individual. The ultimate objective of a health insurance policy is to ensure that the policy buyers have enough funds to take care of medical emergencies.

See Also: Health Insurance Benefits

Does My Health Insurance Policy Cover All My Medical Expenses?

Health insurance policies cover almost all categories of medical costs, which include hospitalization expenses, organ donor expenses, ambulance or transportation expenses, domiciliary treatments, daycare treatment and others.

  • Pre-hospitalization expenses: The expenses incurred by an individual before hospitalization is called pre-hospitalization expenses. If you fall sick, what do you do? First, you must consult a doctor. The doctor may suggest you undergo medical tests if required and prescribe certain medicines. If you get hospitalized as per the advice of the doctor, your health insurance policy reimburses the expenses incurred prior to hospitalization.
  • Ambulance charges: While some health insurance policies cover ambulance charges or transportation expenses, others do not. CignaTTK ProHealth Plan, Royal Sundaram Lifeline Plan, Religare Care, Apollo Munich Optima Restore Plan and Star Family Health Optima Plan are the best health insurance policies around which offer good coverage.
  • Domiciliary expenses: The benefits of a health insurance policy may be extended beyond hospitalization. For example, if you are undergoing medical treatment at home, you incur certain medical expenses. The medical expenses incurred at home are called domiciliary expenses. These expenses are reimbursed as per the terms and conditions of the health policy.
  • Post-hospitalization expenses: Post-hospitalization expenses are the medical expenses incurred after hospitalization. A majority of health insurance plans cover post-hospitalization expenses after 45-90 days from the date of discharge.
  • Organ donor expenses: Organ donor expenses are covered by many health insurance policies in India. These are the expenses incurred for the organ transplant if it is recommended by a physician. The donor’s surgery cost is borne by a health insurance policy.

What should you know about pre and post-hospitalization expenses?

  1. The insurance company must accept the hospitalization claim.
  2. Before or after hospitalization, the policyholder must seek treatment for the same medical condition.
  3. Both pre and post-hospitalization expenses are reimbursed as per the terms and conditions of the policy.

Regular health insurance plans from general insurers

Health insurance is for individuals and families. Individuals can avail separate health insurance policies, whereas families can avail family floater health insurance policies. A family floater policy covers every family member under a single health insurance plan.

Let’s understand how this works with an example. Suppose you have a family floater policy with a sum assured of Rs 3 Lakh. It means that the medical expenses can be claimed up to Rs 3 Lakh a year for your entire family. The expenses beyond this sum assured must be paid separately. The following are the top 4 health insurance companies offering regular health insurance policies in India:

  • Star Heath and Allied Insurance Company Limited
  • Max Bupa Health Insurance Company Limited
  • Apollo Munich Health Insurance Company Limited
  • Cigna TTK Health Insurance Company Limited

See Also: How to Buy Health Insurance Policy?

Combination of regular health insurance policies and top-ups

Regular health insurance policies reimburse the medical and surgical bills up to the given sum assured. On the other hand, top-up health insurance policies cover medical expenses beyond this limit. Suppose you have a regular health insurance policy with a sum assured of Rs 5 Lakh, if you want to enhance this cover by another Rs 5 lakhs; you have two choices:

1) Buying a separate health insurance plan

2) Upgrading the existing plan.

Both options are expensive. Instead of spending so much, go for a top-up health insurance policy in addition to your regular plan. This will meet your requirements.

Premium for critical illness policies

Insurance companies offer health insurance policies exclusively for critical or life-threatening diseases. Premiums for critical illness policies differ from company to company based on features and benefits. Critical Illness Plan is an insurance plan in which an insured is provided a lump sum amount when she or he is diagnosed with a critical illness. Bajaj Allianz Life Insurance Company Limited offers its critical illness plan for a term of 1 year.

Premium for critical illness by Bajaj Allianz



Sum assured





Rs 1 lakh





Rs 3 lakh





Rs 5 lakh 





Rs 10 lakh





Premium for cancer policies offered by life insurance companies

Cancer cases are increasing in India. In 2016, there were about 14 Lakh cancer cases. By 2020, the number of cancer patients is expected to be 17 Lakh as per a recent study.

A cancer insurance policy is necessary because cancer can affect anybody and the treatment cost of cancer is really high.

  • HDFC Life Cancer Care Platinum, which is a cancer insurance policy provided by HDFC Life Insurance Company, can be bought by paying a yearly premium of Rs 6,373. The term of the policy is 20 years.
  • Max Life Insurance Cancer Insurance is a cancer insurance plan offered by Max Life Insurance Company Limited. The yearly premium for this plan is Rs 12,773 and the policy term is 40 years.
  • PNB Met Life Cancer Care Platinum is also a cancer insurance plan that comes with a yearly premium of Rs 18,241. The policy term is 20 years.  

See Also: Family Health Insurance Plan

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