How Does Health Insurance Work?
A health insurance policy is a contract between the insurance provider company and the person who purchased the policy. This contract binds the insurance company to pay for the medical costs required by the insured individual.
A health insurance policy generally consists of a basic plan and a supplementary plan.
The basic plan covers the insured for all kinds of medical expenses incurred during medical treatments and hospitalization. It includes hospital care, operations, daycare treatments, room rent etc. The insurance company either reimburses medical expenditures after the treatment or allows the policyholder to take cashless treatment based on the type of plan.
Individuals can also buy supplementary health plans, usually known as riders, based on their specific health needs. Supplementary plans help to customize the health insurance plan for added benefits.
What is covered in a Health Insurance Plan?
A health insurance plan typically covers the following:
- Cost of diagnosis
- Cost of diagnostic equipment, such as x-ray machines and MRI scans etc.
- Cost of treatment
- Cost of hospitalization
- Cost of room rent
- In addition to preventing injuries, many plans also cover rehabilitation services such as physical therapy and occupational therapy.
- Some policies may include maternity benefits or cover long-term nursing care costs.
When looking for a health insurance plan, it is important to understand what your policy entails to know what benefits will be included. It's important to disclose all preexisting conditions when signing up for a new health policy because this may affect the cost of your monthly premiums.
What is Not Covered in a Health Insurance Plan?
All health insurance providers offer comprehensive plans with maximum coverage. Riders help to buy the additional coverage if required. Yet, there are a few treatments never included in health insurance. These are:
- Cosmetic surgeries are not covered under health plans unless required due to some serious injury during an accident.
- Cosmetic dental treatments are not covered under health insurance.
- Experimental procedures are not covered under health plans.
- Pre-existing conditions are not covered. You need to buy specific riders for them.
- Prescription drugs are not covered under health insurance policies.
- Some policies may also exclude coverage for pre-existing conditions if you had difficulty obtaining health insurance in the past.
Besides this, every other medical procedure is included in a standard personal, family floater policy or a group plan.
While making a claim, you must know what is not covered in your health insurance plan.