A Quick Guide Into The List Of Diseases Covered In Health Insurance

Health insurance plans act as a secure buffer that offer you medical coverage against unpredictable and unplanned health while providing you an opportunity to judiciously invest your financial savings. Therefore, it is imperative that a prospective customer must get the complete understanding of any health insurance policy that he/she intends to buy, coverage benefits under hospitalisation, mediclaim, cashless reimbursements, the list of diseases and medical conditions covered, and other health care services. Though most health insurance policies do provide extensive coverage benefits in terms of the premium sum insured, it is always advised to a customer to carefully read the policy terms and conditions, clauses and caveats of inclusions/exclusions and the list of diseases it covers before opting one.

List of Diseases Covered In Health Insurance

While the diseases covered under a health insurance plan vary from one provider to another, there are invariably some common conditions covered by most insurance companies. Following is a list of medical illnesses and critical conditions of the same:

• Heart Related Ailments/Conditions: Some insurers provide insurance coverage for routine heart check ups at their network hospital facilities but most offer medical coverage for treatment of heart ailments like stroke, heart attack, angina, cardiomyopathy and infarctions
• Critical Illnesses/Conditions: While everyone hopes for a sickness free life, a critical condition or illness can plague one at any given time in life and that’s where a comprehensive, health insurance plan that is tailored to incorporate  critical ailments and emergency conditions comes as a safety net. Enumerated under this category are the critical diseases covered under the critical health insurance policy:

• • Cancer: It is basically uncontrolled growth of pathologic cells that destroy the normal body cells and tissues for example- leukaemia, melanoma, sarcomas, lymphomas etc
  • Angioplasty: This is an invasive procedure that is performed for heart patients who have suffered stroke or having a coronary artery disease where in a stent is introduced in one or more major coronary arteries after detailed examination and diagnosis as mentioned in a Coronary Angiography Report
  • Blindness: This is characterised by a partial or complete loss of eyesight and vision which is confirmed by a licensed ophthalmologist or eye specialist
  • Renal/Kidney Failure: It is a condition described as a chronic irreversible damage of both the kidneys in which they are unable to function smoothly. The diagnosis needs confirmation from a nephrologist or specialised medical practitioner after which dialysis and other supportive renal treatments are administered to a patient
  • Chronic Respiratory/Lung Disease: A severe, chronic respiratory ailment that can cause respiratory failure in which oxygen therapy has to be administered; expiratory volume’s value detected is less than 1 litre; oxygen pressure in arteries found is 55 mmHg or less and difficulty in breathing through lungs
  • High Blood Pressure: Workplace stress, or possibly any other medical condition, is causing an increasing number of people to add their names to the list of blood pressure patients. It is critical to treat high blood pressure as soon as possible because it can lead to blockage in the blood vessels, which can result in a heart attack or stroke. Therefore, it is important to seek immediate medical attention for blood pressure issues, which can be done without any hassles with the help of a health insurance plan.
  • Diabetes: Diabetes is a condition in which the blood sugar levels of the patient are above normal. Generally, there is no permanent cure for the disease, but if it is not prevented, it can lead to more severe conditions like stroke, heart attack, kidney failure, and many others. With the help of a health insurance plan available with comprehensive coverage, a diabetic patient can get the proper treatment without any financial strain.
  • HIV/AIDS: HIV/AIDS is a deadly disease that occurs due to the attack of a virus and affects the immune system of an individual. Though there is no permanent cure for HIV, but it can be controlled with proper medical care. There are many health insurance plans available that provide much needed financial assistance to policyholders for treatment with minimal hassle.
  • Cataract: A cataract is an eye disorder in which the vision of an individual becomes blurry. The operating costs for cataract surgery can potentially exhaust the financial savings of the individual. As a result, you can receive financial assistance from health insurance plans and improve your vision quality without financial constraints.

Preventive And Wellness Coverage

Preventive care and wellness coverage are the insurance benefits provided by an insurer on healthcare services which are deemed as routine, customary medical examinations. Most healthcare plans include eligible preventive care and wellness programs under the cover. Below mentioned are the services included in them:

• Annual Physical Check Ups: Regular health checkups and screenings to detect any potential ailment or condition at an early stage comes under the screening  coverage for eg. osteoporosis, diabetes etc 
• Cancer Screenings: They are highly recommended for employees as part of their medical cover depending upon age and sex for eg. colon,lung, breast, prostate, cervical, skin cancer     
• Vaccinations And Immunizations: Vaccination and immunisation drives conducted as part of group health plans are categorised under this category to prevent potential illnesses from perpetrating in the body. Common infections for which vaccines are administered included Hepatitis, Common flu, Tetanus, measles, mumps etc   
• Wellness Programmes: Many health insurance providers offer healthy diet and nutrition counselling; workshops related to daily exercise regime, yoga and other stress busting activities, fitness coaching; smoking cessation and de addiction programs as part of the wellness programme cover          

Common Inclusions And Exclusions

Inclusions imply the various conditions to provide medical reimbursements and coverages which are incorporated in a health insurance plan. Below are few common inclusions that most providers offer in a well covered health insurance policy:

• Pre And Post Hospitalisation Costs: It incluse healthcare expenses pertaining to pre and post hospitalisation; doctor’s consultation and visit charges; follow up services. Though, it is best suggested that a customer should scan through the T&C listed in the health policy prior to purchasing it
• Annual Health Examination: Routine yearly medical checkups to rule out the possibility and detection of illnesses at an early stage is covered by most health insurance plans. It includes lab diagnostic tests such as ECG; blood sugar; kidney and liver function tests; body mass index etc
• Cashless Hospitalisation Service: This facility ensures that you get admitted in a network hospital without having to pay any advance payment for the admission process as your health insurance provider would be issuing you an identity card under the cashless hospitalisation cover 
• Day Care Treatment: Whenever an insured patient is hospitalised for less than 24 hours to receive medical treatments for daycare procedures like cataract; minor operative procedures; chemotherapy; dialysis etc, it all comes under the inclusion cover of the health policy
• Reimbursement Claim: If an insurer gets hospitalised at a non network healthcare facility, he/she is required to pay the expenses incurred on the hospitalisation procedure out of their own pocket but under reimbursement claim clause, they can reimburse these expenses from their providers by filing a claim
  It is a well known concept that not every health condition will be covered in your health insurance policy and every customer must be well informed about the exclusion scenarios to avoid any last moment bad surprises springing up before them. Exclusion conditions are those illnesses or medical expenses which are not covered in a health insurance policy and the insured is bound to pay for such treatments themselves. Following are few common exclusion conditions in health insurance:
  • Maternity Condition: This clause excludes medical expenses related to pregnancy, IVF, post birth treatment services, abortion etc though few providers do offer a provision of pregnancy cover post the stipulated waiting period mentioned in the policy
  • Aesthetic/Cosmetic Surgery: Any type of skin aesthetic treatments and cosmetic procedures are not accorded coverage benefits as per the generic guidelines of most health insurers
  • Dental, Vision And Ear Conditions: Although exceptional cases exist in case of teeth, eye and ear ailments and conditions depending on the terms and conditions of a health insurance provider but, generally, dental, vision and ear related conditions are not covered under a health policy. Furthermore, it is prudent on an insured person’s part to check with his providers if any additional riders can be bought to ensure coverage benefits for such conditions
  • Pre Existing Illnesses: Most insurance companies do not provide coverage for pre-existing conditions and diseases and if they do then these  benefits are applicable only after the completion of waiting period which varies for different pre-existing ailments. Thus, the insured individual must browse through the policy documents before proceeding with an insurance policy
  • Suicidal Attempts/Tendencies: Intentional self afflicted harm or physical injuries received due to a suicide attempt are not covered by many health insurance providers
  • AYUSH/Alternative Treatment: Generally, health insurers only offer cover for allopathic treatment and alternative therapies like AYUSH, herbal spa, and post accident physiotherapy etc are excluded from being accorded medical coverage
  • Joint Replacement Surgery: Knee, hip joint and similar joint replacement surgical procedures do not generally qualify for medical coverage under a health insurance policy
  • Waiting Period: To understand the waiting period, a customer should check with his provider as he cannot file for claim coverage during this time period. It differs from one insurer to another also, varying for different pre-existing illnesses and maternity conditions.
    Besides the above few exclusion caveats, there are some permanent exclusion conditions for a health insurance policy such as HIV, AIDS, injuries due to nuclear radiation, congenital disorders, etc

Conclusion

Apart from the above-mentioned diseases, a health insurance plan offers several other diseases to its policyholders. You can get the complete list of included diseases under your policy terms, and you can include certain disorders according to your medical requirements.

FAQs

Ques 1. Enlist the diseases that get covered under a health insurance plan?

Ans. Though the list of diseases that get covered under a health insurance plan vary from one insurer to another but few common conditions which receive coverage are high blood pressure; diabetes; cataract; dengue; cancer and critical illnesses like infarctions; multiple sclerosis; paralysis etc

Ques 2.  What are the diseases which do not get covered under a health insurance plan?

Ans.  Exclusions are applicable on illnesses which are not covered in a health insurance policy for eg. cosmetic surgery; addiction toxicity; injuries caused by self harm; IVF/infertility treatment and cosmetic surgeries