With the medical inflation rate in India at 13%, it has now become more necessary than ever to get a mediclaim policy. Such policies help cover the costs of treatment, medicines, and even aftercare after hospitalisation.
A medical insurance coverage policy has both inclusions and exclusions. In this article, we will discuss in detail the common inclusions that you can get in a medical insurance policy, along with how digital healthcare initiatives like abha card benefits can complement your coverage.
Importance of Checking for Inclusions in a Medical Insurance Coverage
Having a clear idea about the inclusions of your medical insurance coverage will clarify the extent of benefits to your policy. It will also make you aware of the limitations and help you make informed decisions.
Top Inclusions of Medical Insurance Coverage in 2025
Here is a list of some of the popular medical policy inclusions:
In-Patient Hospitalisation
An in-patient hospitalisation refers to hospitalisation for 24 hours or more. A medical insurance coverage provides for these expenses as well, up to a limit based on the type of policy that you opt for.
Pre-Existing Disease
Pre-existing disease refers to a medical condition that you already had before purchasing health insurance coverage. Generally, a pre-existing disease period ranges from 12 months to 24 months to 36 months. The defined period for it differs from insurer to insurer.
Pre-Hospitalisation Expenses
Pre-hospitalisation expenses coverage is a popular inclusion in a majority of health insurance policies. They cover doctor consultation fees, medicine costs, diagnostic charges, etc.
Policies include pre-hospitalisation coverage for expenses that occur up to 90 days before admission to a medical facility.
Post-Hospitalisation Expenses
These expenses are incurred after discharge from the hospital. They include coverage for physiotherapy procedures and any follow-up consultations during the recovery period.
Coverage for these expenses up to 180 days after hospitalisation is given under post-hospitalisation expenses.
Day Care Treatments
Day care treatments are those which require less than 24 hours of hospital stay. A few examples of such treatments are cataract surgery, dialysis, chemotherapy and tonsillectomy.
Note: Make sure to thoroughly read the policy documents to get a clear idea about the covered daycare treatments.
Preventive Healthcare
Preventive health check-ups are necessary to prevent any diseases in the future. Medical insurance policies provide coverage for that.
Certain health insurance policies cover annual health check-up facilities. For instance, blood tests, ECG. These are preventive health check-up facilities. They help with timely intervention.
Maternity Benefit
Women-focused health insurance policies provide maternity benefits such as delivery expenses (both normal and C-section) and newborn coverage for babies from day 1. This kind of coverage is also available in family health insurance policies.
Organ Donor Expenses
Medical insurance policies cover the whole transplantation treatment. Additionally, the in-patient hospitalisation expenses incurred during organ transplant surgery are also covered in the majority of medical insurance policies.
AYUSH Treatment
The modern health insurance policies also cover alternative medicine and practices, namely AYUSH treatment (Ayurveda, Yoga, Unani, Siddha and Homoeopathy).
However, it is important to note that insurers will only cover these expenses if the treatment is taken from a recognised government hospital or institute.
Modern Treatment
Expenses incurred for modern treatments, such as Intra-Vitreal injections, Oral Chemotherapy, and Robotic Surgeries, are also included in medical insurance policies. This is only available up to the specified limits mentioned in the policy.
Ambulance Coverage
Ambulance expenses may seem like no big deal at first, but they add up to the overall expenses. A good medical insurance coverage includes expenses for that.
Depending on the type of policy that you get, medical insurance coverage includes road ambulance as well as air ambulance coverage.
Second Medical Opinion
Various medical insurance coverage in India covers a second medical opinion. It refers to a person going for a second perspective or diagnosis.
The insured person is eligible to get a second medical opinion from a doctor in the company’s network of medical practitioners.
Vaccination Expenses Coverage
The family medical insurance policies cover vaccination expenses. These expenses are covered for a newborn baby, but only up to specified limits stated in your policy.
Domiciliary Treatment
Domiciliary treatment refers to at-home treatment. When the patient is unable to travel to the hospital for treatment, they get domiciliary treatment. During this, the patient receives treatment in the comfort of their home.
However, make sure that your health policy insurer will only cover domiciliary hospitalisation for patients under an active health plan who have received treatment for at least 3 days.
Final Words
Make sure to thoroughly check the policy terms and conditions when opting for medical insurance coverage policies. Additionally, also check for the inclusion’s limits and sub-limits. They will help you avoid any surprises when you try to make a medical insurance claim in the future.
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