What Does a Health Insurance Policy Cover?

Posted on: Sep 1, 2025 | 3 mins | Written by: HDFC ERGO Team

What Does a Health Insurance Policy Cover?

A medical emergency can strike when you least expect it and quickly drain your savings. A health insurance policy provides financial protection during these stressful times, helping you focus on getting the best possible treatment and recovering faster. If you are thinking about securing both your health and your finances, and wondering what is covered in health insurance, this blog will walk you through it.

Inclusions in Health Insurance

Here are some of the common inclusions of a comprehensive health insurance policy:

Inpatient Hospitalisation

If you are admitted to the hospital for more than 24 hours, the insurer will cover your inpatient hospitalisation expenses, such as room rent, diagnostic tests, ICU bills and more.

Pre-and post hospitalisation Expenses

A comprehensive health insurance policy may also cover medical expenses incurred before hospitalisation and post-hospitalisation expenses, such as cost of medicines, follow-up visits and physiotherapy, for up to 180 days.

Pre-existing Conditions

Most health insurance policies cover pre-existing conditions after a waiting period of 2-3 years.

Daycare Treatments

Many insurance policies cover daycare procedures or treatments that require less than 24 hours of hospitalisation. These may include cataract surgery, chemotherapy, dialysis and more.

Preventive Health Check-ups

A health insurance policy may also cover preventive health check-ups such as blood tests, kidney function tests, ECGs and more.

Mental Healthcare

Health insurance policies also cover treatment for mental health issues, such as anxiety, depression, bipolar disorder and sleep disorders.

Organ Donor Expenses

If you ever need an organ transplant, your policy may cover the donor’s medical expenses, including compatibility tests, surgery, hospital stay and recovery.

Maternity and Newborn Coverage

Many health insurance policies also cover maternity expenses, but only after a waiting period that may range from 3 months to 4 years.

Conclusion

Health insurance coverage can vary from one insurer to another. That’s why, when you are looking to buy a plan, it is a good idea to shortlist a few options and compare what each one offers. This way, you can pick a policy that fits both your healthcare needs and your budget.

FAQs

Do all health insurance plans have the same inclusions?

No, all health plans don’t have the same inclusions. The coverage of a policy usually varies based on the type of plan and the insurance provider.

What is not covered in health insurance?

Most health insurance policies do not cover the following:

Dental and vision care (unless due to an accident)

Cosmetic surgery

Self-inflicted injuries

War-related injuries

Congenital conditions

Substance abuse

Experimental or unproven treatments

Are pre-existing diseases covered under health insurance?

Yes, health insurance policies cover pre-existing conditions, but only after a waiting period of 2-3 years, depending on the insurer and the specific condition.

Are mental health conditions covered under health insurance?

Yes, as per IRDAI guidelines (2020), all health insurance policies must cover mental health conditions. such as anxiety, depression, sleep and eating disorders and dementia.

Are OPD visits and medicines covered?

No, standard health insurance policies usually do not cover OPD (outpatient department) expenses. However, some premium plans may offer OPD benefits, or you can buy them as add-on covers.

Disclaimer: The above information is for illustrative purposes only. For more details, please refer to the policy wordings and prospectus before concluding the sales.

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