Summary of this article
Health insurance excludes consumables unless a specific add-on covers these costs.
OPD visits, diagnostics, and routine medicines need an optional OPD add-on cover.
Pre-existing diseases remain uncovered during the mandatory waiting period window.
Dental care and AYUSH treatments are covered only with limits or sublimits.
Health insurance is a must today, as episodes of hospitalization can be costly. However, health insurance does not cover all costs associated with healthcare. These are specifically excluded, and it is important to be aware of these as a policyholder.
Non-Medical And Consumable Expenses
When someone is admitted, a variety of consumables are required, including gloves, syringes, masks, and others. The cost of consumables can be five to 15 per cent of the hospital bill. These will not be covered by health insurance unless you have a consumables add-on added to your health insurance policy.
Outpatient Department (OPD) Expenses
Routine doctor visits, diagnostic tests, and medicines that are prescribed on a regular basis are also not covered by standard health insurance policies. To get these covered, you will need an OPD add-on to your base health insurance policy. Read to know whether an OPD add-on makes sense. Also, routine checkups for the eyes will not be covered under a standard health insurance policy.
Pre-Existing Diseases (During The Initial Waiting Period)
The Insurance Regulatory Development Authority of India (Irdai) has reduced the maximum waiting period for pre-existing diseases (PED) from four years to three years, effective April 1, 2024. Hospitalisation for a certain ailment will not be covered before this waiting period is over. However, there are policies that provide you with Day 1 coverage for an extra premium. However, even for such policies, conditions like cataract will still have a waiting period. If you already have a pre-existing disease, taking an insurance policy that does away with the waiting period may make sense.
Routine Dental Care
Dental procedures like root canal treatment can be expensive, but standard health insurance policies do not cover them. You can pay an extra premium to get it covered, but there is a limit of, say, Rs 25,000 beyond which you need to pay out of your own pocket.
Alternative/Non-Allopathic Treatments
Alternate treatments like Ayush have to be mandatorily covered, Irdai has said. Even then, they are not fully covered and are covered with certain limits. It is important to know what is covered and what is not before you sign up for a policy. For example, immunotherapy for the treatment of cancer is mostly covered by health insurance, but it may come with sublimits.
