Choosing the right health insurance plan is crucial for ensuring complete protection and peace of mind. It’s important to review the plan's coverage to confirm it meets your needs, minimises unforeseen expenses, and offers financial security in case of accidents, illnesses, or other covered situations.

By considering aspects like hospitalisation, critical illness coverage, maternity benefits, and outpatient services, you can make an informed choice tailored to your healthcare needs. This guide highlights 12 essential covers to consider when buying health insurance to get optimal value and protection for yourself or your family.

12 Covers Your Health Insurance Policy Must Include

Here are 12 essential covers that your health insurance policy should include: 

1. Inpatient Hospitalisation

Covers medical treatments requiring hospital admission for at least 24 hours, including room and board, nursing care, diagnostic tests, medications, and surgeries.

2. Health Check-ups

Health policies often offer preventive checkups, tests, and vaccinations, starting either at policy inception or after 2-4 claim-free years. These are usually available at network hospitals or reimbursed if done at non-network hospitals.

3. Air Ambulance

Covers expenses incurred on Air Ambulance in the event of a life-threatening emergency of the Insured Person, where road transport is not feasible. Coverage limits, geographic restrictions, and prior authorisation may apply.

4. Restoration of the Sum Insured

This feature allows for the restoration of the sum insured after its base Sum Insured is completely exhausted or insufficient due to a previous claim made in the policy year, ensuring continuous coverage even after claims deplete the initial amount.

5. Daycare Procedures

Covers treatments and surgeries that don't require 24-hour hospitalisation, such as cataract surgery and dialysis.

6. Domiciliary Hospitalisation

Provides coverage for treatment received at home (including doctor visits, medications, and necessary medical equipment) when hospital admission isn’t possible due to the patient’s condition or lack of hospital beds. However, the coverage details, such as duration and specific situations, can vary between policies.

7. Maternity and Newborn Cover

Covers regular check-ups , ultrasounds, delivery costs, and postnatal visits. It also includes newborn care, such as health assessments, vaccinations, and initial

8. New Age Treatment and Treatment for HIV/AIDS and STDs

Covers Modern Advanced treatments like immunotherapy, robotic surgery, and also provides coverage for HIV/AIDS and sexually transmitted diseases (STDs).

9. Critical Illness Cover

Offers a lump sum payment if the insured is diagnosed with a specified serious illness, such as cancer, heart disease, kidney failure, etc., helping to cover treatment costs and financial burdens during recovery

10. Organ Donor Expenses

It covers the medical expenses related to the organ donation process, including hospital stays and surgical procedures. Depending on the plan's terms, it ensures financial support for both the donor and recipient.

11. AYUSH Treatment

Covers alternative treatments like Ayurveda, Yoga, Unani, Siddha, and Homoeopathy, ensuring comprehensive care beyond conventional medicine.

12. Mental Health Cover

Provides coverage for mental health treatments, including therapy, counselling, and psychiatric services, addressing conditions like anxiety and depression.

Additional Considerations Before Buying a Health Insurance Plan

Aside from ensuring adequate coverage, there are a few more things to know before buying health insurance. It's essential to consider the following factors before settling on a health insurance plan for yourself:

Pre And Post-Hospitalisation

Pre-hospitalisation covers medical expenses (like medical tests and reports) incurred before hospitalisation, typically for 30 to 60 days. On the other hand, post-hospitalisation covers medical expenses (like diagnostic tests, consultation, Pharmacy medicine, etc.) incurred after discharge from the hospital, usually for 45 to 90 days. 

Waiting Period Clause

A waiting period in health insurance refers to the duration an insured individual must wait before certain benefits are accessible. This period typically spans 24 to 48 months, depending on the insurer and selected plan. It may encompass conditions such as hypertension, diabetes, and cataracts. Choosing a plan with the shortest waiting period is essential to facilitate timely claims in emergencies. 

No Claim Bonus

A no-claim bonus in health insurance is a reward given by insurers to policyholders who don't file any claims during a policy year. This bonus can be in the form of a discount on the premium for the next year or an increase in the sum insured at no extra cost. 

Co-payment Clause

Some insurance companies require co-payments, while others offer them as an option. Selecting a lower co-pay results in higher premiums but lowers the claim amount. Conversely, a higher co-pay decreases the premium but raises the claim amount. It is prudent to choose a co-payment only if you can cover the remaining claims. 

Cashless Health Insurance

Cashless health insurance allows policyholders to receive medical treatment at network hospitals without paying up front. The insurer directly settles the bills with the hospital, simplifying the process and reducing the financial burden on the insured. 

Room Rent Capping

Room rent capping in health insurancedenotes the highest amount an insurance policy will reimburse for daily hospital room expenses. Should the actual rent surpass this cap, the policyholder must cover the excess costs personally, potentially increasing overall medical expenses. However, some policies can extend your room rent cap, and others don't have a limit at all. 

Policy Limitations

When selecting medical insurance, reviewing the policy coverage and limitations is crucial. It's important to note that most insurers typically do not cover the following: 

1. Terminal illness 

2. Cosmetic procedure 

3. Infertility treatments 

4. Weight loss programs

5. Dental and eye care 

6. Common diseases and many others 

Quick Claim Settlement

When picking a health insurance plan, it's crucial to thoroughly investigate the insurer's claim settlement history. A quick claim settlement means the insurer efficiently processes and pays out claims. Checking the claim settlement ratio and customer reviews online is critical to gauge this. 

Flexibility of Covers

Some policies provide additional protection and financial security beyond the basic coverage. These add-ons can include benefits like enhanced maternity coverage, critical illness protection, or extended hospital stay benefits, which can be vital for managing unforeseen health expenses. You can customise your insurance to fit your unique needs, providing extensive coverage to reduce costs and bring peace of mind in health situations. 

Comprehensive Health Insurance Plans with Wide Coverage That You Can Consider 

Now you know what to consider while buying health insuranceand how the coverage and benefits can help you get the best medical services in a time of need. ManipalCigna Health Insurance, too, understands this, and that's why its health insurance plans are thoughtfully crafted so that the insured gets all the essential coverage. 

Two ManipalCigna plans that you can get extensive coverage from are: 

1. ManipalCigna Sarvah Uttam
2. ManipalCigna Sarvah Param

Here are a few things you should know about these plans: 

Conclusion

When selecting a health insurance plan, it is vital to assess key coverage options to ensure thorough protection. Essential elements include hospitalisation benefits, coverage for pre- and post-hospitalisation expenses, maternity benefits, and critical illness coverage. Furthermore, benefits can be advantageous for outpatient department (OPD) visits, daily hospital cash allowances, and alternative treatment coverage such as Ayurveda and Homoeopathy. 

Careful evaluation of these aspects aids in choosing a plan that aligns with medical and financial requirements, offering reassurance and economic stability during health crises. Prioritising these covers will lead to an informed decision for your health insurance plan. 

Key Takeaway

The selection of health insurance is no longer a matter of picking a high sum insured policy-it is a matter of being sure that the plan has substantial coverage whenever you need it most.Increased medical cost and the rising health care demands is something that will make your financial burden be minimised with a policy that will cover the basic requirements like hospitalisation, day care procedures, ambulance services, pre-and post-hospitalisation coverage, and critical illness coverage.

The flexibility of plans: the ability to tailor your coverage according to your lifestyle, age, medical history, and family needs is one of the greatest benefits of contemporary health insurance programs.Some optional benefits, such as room rent waiver, maternity cover, OPD benefit, and annual health check-ups, can be added to your plan without causing a significant premium increase.

Hospitalisation without cash is still one of the key decision-makers, and it is always best to find an insurer with a broad network of hospitals so that they can conveniently rely on them in case of an emergency.It is also necessary to know about waiting periods, sub-limits, and co-payment provision since they will have a direct impact on your out-of-pocket payments on your claims.

Finally, the goal of health insurance is long-term financial protection. A well-rounded plan ensures timely medical attention, prevents savings from being wiped out, and offers peace of mind. As you evaluate your options, focus on comprehensive coverage, transparent terms, and long-term benefits rather than short-term savings on premiums. Your health insurance should feel like a reliable partner-one that supports you through all stages of life.

Understand inclusions and exclusions before finalising your plan.

When buying a health insurance policy, the most crucial yet often overlooked step is reviewing the inclusions and exclusions. These elements determine what your insurer will cover-and what they won’t-during a claim. Many policyholders assume their plan covers every medical scenario, only to realise during hospitalisation that a treatment, room type, or diagnostic service isn’t included. To avoid such surprises, examine the policy document in detail before signing up.

Begin with inclusions-they usually include cost of hospitalisation, surgery, medications, ICU stays, and physician fees.Additionally, seek coverage of advanced procedures such as robotic surgery, organ transplant services, psychiatric insurance, and new-fangled daycare services like dialysis or chemotherapy.Prevention and care benefits, yearly check-ups, and wellness programs are good supplements that facilitate long-term health.

Exclusions, on the other hand, define what the policy will not pay for. Common exclusions include cosmetic procedures, non-medical consumables, self-inflicted injuries, experimental treatments, and illnesses diagnosed before the waiting period ends. Some policies also have disease-specific exclusions, limits on maternity expenses, or restrictions on room rent that can increase out-of-pocket payments.

Understanding these terms helps you make an informed decision, compare plans effectively, and choose the one that best suits your needs. If certain exclusions bother you, consider add-ons or riders that expand the coverage. Ultimately, clarity on inclusions and exclusions ensures smoother claims, fewer disputes, and a more dependable health insurance experience.

FAQs 

• What services are typically covered by health insurance plans? 

Ans. Most health insurance plans cover essential health benefits such as emergency services, hospitalisation, prescription drugs, maternity and newborn care, mental health services, and preventive services like vaccinations and screenings. Coverage specifics can vary by plan. 

• Does my health insurance cover pre-existing conditions? 

Ans. Under the Affordable Care Act (ACA), health insurance plans must cover pre-existing conditions without charging higher premiums. Check your specific plan details to confirm. 

• What is the difference between in-network and out-of-network coverage? 

Ans. In-network coverage refers to services provided by healthcare providers with a contract with your insurance plan, usually at lower out-of-pocket costs. Out-of-network coverage applies to providers who do not have a contract with your insurer and generally results in higher out-of-pocket costs. 

• What is a health insurance deductible? 

Ans. A deductible is the out-of-pocket amount for covered healthcare services before your insurance plan starts to pay.