List of Diseases Covered Under Health Insurance in India 2025

In today's world, having health insurance or a mediclaim policy has become essential. With rapidly spreading diseases and medical inflation, health insurance provides 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 discuss the list of diseases covered under health insurance and those not covered, so you can make an informed decision.

List of Diseases Covered Under Health Insurance

Various diseases are included under health insurance; however, the specific 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, 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, respiratory droplets are transmitted, causing the disease to spread. Health insurance companies provide coverage for the COVID-19 pandemic as the virus has affected the entire world. Insurers cover hospitalization charges, offering proper treatment. Some insurers even cover pre and post-hospitalization expenses to a certain extent.

Cancer

Cancer is a life-threatening disease 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. Although treatments for cancer are more accessible nowadays, the expenses are often too high, causing financial distress. Having health insurance that covers such diseases 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 and blood vessels are known as cardiovascular diseases. This issue originates from plaque accumulating within our arteries, and heart attack and stroke are two well-known types of heart conditions found in India. Sedentary lifestyles, unhealthy diets, and increasing stress levels have caused a significant rise in cardiovascular disease cases in India. The majority of insurance companies cover heart disease, and some even cover heart health checkups.

Diabetes

Diabetes is a long-term condition marked by elevated blood sugar levels. It is a chronic condition that negatively impacts the body's processing of glucose in the blood. Diabetes is prevalent among a significant percentage of the Indian population. It is often called a 'silent killer' because it progresses slowly with few early symptoms.

Cataract

A cataract is an eye ailment characterized by a cloudy lens that hinders vision, making everything appear blurry. It commonly affects older people. Cataract surgery is common but can be a financial burden if not covered by health insurance.

High Blood Pressure

High blood pressure can be caused by various factors, including stress, lifestyle habits, or underlying medical conditions. You are diagnosed with high blood pressure if your readings are consistently elevated. This can damage arteries, leading to stroke or heart attack. A health insurance plan helps you get timely treatment without having to worry about the monetary factor.

List Of Diseases Not Covered Under Health Insurance

Even though many diseases are covered under health insurance, certain diseases are not covered. The following is the list of diseases not covered under health insurance:

Cosmetic Surgery

Cosmetic surgery, such as facelifts, nose jobs, or Botox, is primarily performed for aesthetic enhancement. It is generally not covered by health insurance as it is not considered a life-saving or crucial medical treatment.

Genetic Disorders

Genetic disorders are conditions present at birth. These can be internal or external. Genetic or congenital diseases are typically not covered by health insurance.

Voluntary Abortion

Voluntary abortions are not covered under health insurance due to legal restrictions in India.

Infertility and IVF Treatments

Infertility and IVF treatments are generally not covered by health insurance due to their high cost and classification as non-crucial medical treatments.

HIV/AIDS

HIV is a chronic disease that affects the immune system, caused by a viral attack. Currently, there is no cure for HIV, requiring lifelong management and regular treatments. The HIV virus can advance to AIDS. Most insurance companies do not cover HIV/AIDS due to the lifelong nature of its treatment.

Conditions due to consumption of intoxicating substances

Health conditions arising from the consumption of intoxicating substances like drugs, smoking, and regular alcohol use are not covered by insurance companies.

Self-inflicted Injuries

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

Conclusion

With widespread diseases and rising medical expenses 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 what diseases are covered under health insurance and which are not. By following this approach, they will be able to make sensible choices and pick a plan that meets their particular needs.

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