Common Inclusions of Health Insurance

What Are the Inclusions in Health Insurance?

Health insurance policies cover specified expenses, which are known as inclusions in health insurance. Depending on the insurance company and plan, inclusions can cover medical treatments, medications, and health check-ups.

Before you buy any health insurance policy, it is strongly advisable to check the inclusions to ensure you are aware of all aspects the policy covers. This helps you make the right decision and buy the policy most suitable for your needs.

Best Health Insurance Plans in India in 2025

The inclusions of health insurance vary depending on the plan and insurance company. We have listed the top health insurance plans and their inclusions below.

15 Key Inclusions of Health Insurance in India

Mentioned below are the most common inclusions of health insurance in India:

1. In-patient Hospitalization

   If a patient is in the hospital for more than 24 hours, it is known as in-patient hospitalization. Some insurers count hospitalization even if it's more than 2 hours (based on discharge summary). This includes the cost of hospital room, Intensive Care Unit (ICU) treatment, nursing care, medicines & drugs, diagnostic tests, operation theatre charges, and more.

2. Pre-hospitalization Expenses

   Most health insurance policies offer coverage for expenses that occur before hospitalization. These costs include doctor consultation fees, diagnostic tests, prescribed medicines, OPD expenses, pre-surgery evaluations, and specialist review fees.

3. Post-hospitalization Expenses

   Even after the patient has been discharged, most health insurance policies cover expenses such as the cost of follow-up consultations, medical tests, medications, and any necessary treatments during the recovery period. Post-hospitalization expenses are usually covered for up to 60, 90, or 180 days.

4. Day Care Treatments

   Day care treatments are those that do not require a 24-hour hospital stay. Procedures such as cataract surgery, chemotherapy, dialysis, radiotherapy, tonsillectomy, and sinusitis treatment come under day care treatments.

5. Pre-existing Diseases

   A pre-existing disease is disclosed to the insurance company before the insurance policy has been purchased. Health insurance plans cover these diseases after a waiting period of 2 to 3 years. It is necessary to let the insurance company know about any pre-existing diseases at the time of purchasing the policy. A few companies provide add-ons to reduce the PED waiting period.

6. Ambulance Expenses

   Health insurance plans also cover ambulance expenses. This ensures that the person in need receives quick medical assistance. You should definitely check for this inclusion before purchasing a health insurance policy.

7. Consumables Cover

   Consumables cover is a common inclusion in health insurance plans. It covers the costs of non-medical items such as PPE kits, sterile dressings, syringes, packaged water, disposable gloves, and paper tissues.

8. Organ Donor Expenses

   In the event of a transplant surgery, insurance companies offer plans that cover the cost of harvesting the donated organ. Organ donor expenses include the costs of organ matching tests, hospital stay, expenses before and after admission, post-operative care, and healing support.

9. Modern Treatment

   IRDAI has provided a list of 12 modern treatments that health insurance plans need to cover. As per this list, insurance companies cover the cost of procedures such as immunotherapy, oral chemotherapy, intravitreal injections, robotic surgeries, stereotactic radiosurgeries, bronchial thermoplasty, and HIFU.

10. Domiciliary Treatment

    Domiciliary treatment means treatment taken at home. Sometimes, due to the patient's condition or other issues, hospitalization may not be possible. In such a case, the person is treated at home, at the recommendation of an attending doctor. The coverage generally includes expenses like medications, nurse charges, and doctor visits. Coverage applies if it is medically necessary and doctor-advised, and if hospitalization for 3+ days is required but not possible due to the patient’s condition or lack of beds.

11. Maternity Benefit

    Maternity benefits usually have a waiting period that can range from 9 months to 4 years, depending on the policy. Both normal deliveries and C-sections are covered under this benefit. In most cases, pre- and postnatal costs are also covered.

12. Mental Health Cover

    IRDAI has mandated all insurance companies to provide mental health cover as a part of their inclusions. The costs incurred in treating mental health issues such as acute depression and anxiety are covered by health insurance companies.

13. AYUSH Treatment

    AYUSH treatments have specific conditions for coverage. Most plans cover inpatient treatment, but IRDAI mandates full coverage at recognized facilities, and some now include AYUSH OPD or wellness benefits. It is also mandatory for the insured to be admitted to a government hospital or institute recognized and/or accredited by the Quality Council of India or the National Accreditation Board.

14. Preventive Health Check-ups

    Preventive health check-ups include basic tests such as blood tests, urine tests, blood sugar, lipid profile, liver function test, kidney function test, and ECG.

15. Second Medical Opinion

    Under this cover, the insured can consult another specialist for a second diagnosis or perspective. You should check for this inclusion if you are buying a critical illness health insurance plan.

Why You Should Check the Inclusions of a Health Insurance Plan Before Buying

• Understand What's Covered

  Going through the list of inclusions can help you understand if a certain policy is suitable for you. You can match the inclusions with your requirements and find a policy that fits your needs.

• Avoid Claim Rejections

  If you buy a policy without knowing what is included, you might end up filing a claim for an expense that is not a part of the plan. This can result in claim rejection.

• Compare Plans Smartly

  Compare plans based on what each of them covers. You can choose from the list of health insurance policies to ensure all your needs are met.

• Avoid Overlapping Covers

  Knowing about the coverage of a health insurance plan ensures that you don't end up buying policies offering the same benefits. This is especially needed for people who already have a running health insurance plan.

Conclusion

This article covers the inclusions that are most commonly offered by health insurance companies. Checking inclusions in your health insurance policy helps you understand what the policy covers, avoid claim issues, and choose the right plan.

To know more about health insurance plans, you can visit PolicyX.com. If you are looking for real insurance advice, you can book an appointment with us today.

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