Diseases Covered Under
Health Insurance
  • Coverage of Health Insurance
  • Diseases Covered
  • Uncovered Diseases List
Diseases Covered Under Health Insurance
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List of Diseases Covered Under Health Insurance in India 2024

In the world that we live in today, it has become necessary to have a health Insurance or a mediclaim in your name. Between rapidly spreading diseases and medical inflation, health insurance acts as a comfort to the policyholder. It is necessary to know the list of diseases that are covered as well as excluded before buying a health insurance policy for yourself and your loved ones. In this article, we will talk about the diseases that are covered and the diseases that are not covered under health insurance so that you can make an informed decision.

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List of Diseases Covered Under Health Insurance

There are various diseases that are included under health insurance, however, the disease list may vary from insurer to insurer. The following is a common list of diseases covered under health insurance:

Novel Coronavirus Or COVID-19

COVID-19 that is caused by the SARS-CoV-2 virus is a deadly communicable disease depending upon its variant. When an infected individual coughs, sneezes or even talks in close proximity, the respiratory droplets are transmitted, causing the disease to spread. Health insurance companies give coverage for COVID-19 pandemic as the virus has taken over the entire world. The Insurers cover hospitalisation charges offering proper treatment. Some insurers even cover pre and post hospitalisation expenses to a certain extent.

Cancer

Cancer is a life-threatening disease that is caused by uncontrolled and abnormal cell growth with the potential to invade or spread to other parts of the body. Cancer can be detected in any part of the body and though the treatments for Cancer is more accessible nowadays the expenses are way too much to cause financial distress. Having health insurance or having such diseases covered under mediclaim would be quite helpful and beneficial. The health coverage may vary depending on the insurer and the policy terms, it may include chemotherapy, hospital bills, medicines involved etc.

Cardiovascular Diseases

Conditions that impact both the heart as well as blood vessels form a part of what is called cardiovascular diseases. This issue originates from plaque accumulating within our arteries, and heart attack and stroke are the two well-known types of heart conditions found in India. Sedentary lifestyle , unhealthy diet and increasing stress levels have caused a significant increase of cardiovascular diseases cases in India. Majority of the insurance companies cover heart disease and some of them even cover heart health checkups.

Diabetes

Elevated blood sugar levels mark a long-term condition called diabetes. The body's processing of glucose in the blood is negatively impacted by diabetes - a chronic condition. Diabetes is prevalent among a significant percentage of the Indian population. The 'silent killer' is a term frequently used because it progresses slowly and has no symptoms in the early stages.

Cataract

Cataract is an eye ailment due to a cloudy part in the eye lens which hinders your vision and everything seems blurry. It is common to happen to older people. A cataract surgery is a very common surgery but can turn into a financial burden if not covered in the health insurance plan.

High Blood Pressure

High blood pressure can be caused due to various reasons but the main reasons can be stress lifestyle habits or underlying medical conditions. You are declared to have a high blood pressure if your blood pressure is consistently high. This causes problems to the arteries and leads to stroke or heart attack. A best health insurance plan helps you get timely treatment without having to think about the monetary factor.

List Of Diseases Not Covered Under Health Insurance

Even though there are a lot of diseases that are covered under health insurance, there are certain diseases that are not covered. Following is the list of diseases not covered under health insurance:

Cosmetic Surgery

Cosmetic surgery is majorly done by people to enhance beauty such as facelift, nose job, botox etc. This is not covered by health insurance companies as it doesn’t fall into the category of life-saving or crucial treatments.

Genetic Disorders

Genetic disorders are conditions that a person is born with i.e. the person has these conditions by birth. It may be something internal or external. Genetic disorders or congenital diseases are not covered by health insurance companies.

Voluntary Abortion

No voluntary abortions are covered under health insurance as there are restricted laws for abortion in India.

Infertility and IVF Treatments

Infertility and IVF treatment are not covered under health insurance companies as they are very costly and are not considered crucial medical treatment.

HIV AIDs

HIV is a chronic disease that affects the immune system and is caused by an attack of a virus. Till now, there is no found cure for HIV but it needs to be treated lifelong and a balance needs to be maintained with regular treatments. A HIV virus can advance and turn into AIDs. Most of the insurance companies do not cover this due to the lifelong nature of treatment.

Conditions due to consumption of intoxicating substances

An insurance company doesn’t cover health conditions due to consumption of intoxicating substances such as drugs, smoking and regular consumption of alcohol. Regular consumption of intoxicating substances then becomes a lifestyle habit.

Self-inflicted Injuries

A health insurance company does not cover intentional injuries caused upon oneself such as a suicide attempt etc.

Conclusion

With diseases being widespread and medical expenses on the rise in today's world, it's necessary to have health insurance or a mediclaim as medical expenses can be overwhelming. Careful examination of a health plan is necessary for people to identify which diseases it covers and which it does not. By following this approach, they will be able to make sensible choices and pick a plan that meets their particular needs.

Diseases Covered Under Health Insurance: FAQ's

1. What diseases are covered under health insurance?

Typically, COVID-19, cancer, heart disease, diabetes, cataract, high blood pressure, asthma, and thyroid disorders are covered by health insurance. However, the coverage might vary between insurance providers, therefore it's crucial to verify the particular terms of the policy.

2. Does health insurance cover cosmetic surgery?

No, cosmetic surgery is typically not covered by health insurance. This includes operations like facelifts, nose jobs, and botox. These therapies are not necessary for life-saving or important treatments and are regarded as optional procedures.

3. Does health insurance cover HIV/AIDS treatment?

Due to the lifelong nature of the medication, the majority of insurance companies do not cover HIV/AIDS treatment. HIV is a chronic illness that necessitates constant medical attention, yet insurance companies seldom cover it and typically don't cover it at all.

4. Can I purchase health insurance right before the surgery?

There are often waiting periods before some surgeries or treatments are covered by health insurance policies. Health insurance should be purchased well in advance because last-minute purchases might not offer instant coverage for surgery. Review the policy's conditions and waiting periods to determine when coverage for procedures will start to apply, otherwise, submitted claims will be denied.

5. How many times can I claim health insurance?

The individual policy's maximum coverage or sum assured amount, as well as the number of claims you can make, all depend on the situation. Therefore, as long as the claims do not go over the insurance company's established coverage limits, you may submit several claims within the insurance period.

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Daina Mathew

Written By: Daina Mathew

Daina is a content writеr with a profound grasp of Insurancе, Stocks, and Businеss domains. Hеr extensive 3-year еxpеriеncе in thе insurancе industry еquips hеr with a nuancеd undеrstanding of its intricaciеs. Hеr skills еxtеnd to crafting blogs, articlеs, social mеdia copiеs, vidеo scripts, and wеbsitе content. Her ability to simplify complex insurancе concepts into reader-friendly content makes her an еxpеrt in the domain.