Top 12 Essential Covers to Look Out for in a Health Insurance Plan

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, minimizes 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 emergencies of the Insured Person, where road transport is not feasible. Coverage limits, geographic restrictions, and prior authorization 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 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, 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 Homeopathy,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 Consideration Before Buying a Health Insurance  

    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 etc. 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 result 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 upfront. 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 insurance denotes 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: 

• Terminal illness 

• Cosmetic procedure 

• Infertility treatments 

• Weight loss programs 

• Dental and eye care 

• 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 insurance and 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: 

Features	ManipalCigna Sarvah Uttam	ManipalCigna Sarvah Param
Sum Insured Options	₹5L to ₹300L	₹5L to ₹300L
Scope of Cover	Comprehensive coverage	Comprehensive coverage with Zero Waiting Period.
Base Covers	In-patient hospitalisation (This benefit shall also offer coverage towards listed Modern and Advanced Treatment, Treatment towards HIV/AIDS & STD, Mental Illnesses, Day Care Treatment, Pre & Post hospitalisation, Domiciliary Hospitalisation, Road Ambulance, Donor Expenses, AYUSH Treatment.	In-patient hospitalisation (This benefit shall also offer coverage towards listed Modern and Advanced Treatment, Treatment towards HIV/AIDS & STD, Mental Illnesses, Day Care Treatment, Pre & Post hospitalisation, Domiciliary Hospitalisation, Road Ambulance, Donor Expenses, AYUSH Treatment, Restoration, Gullak (Guaranteed Cumulative Bonus)
Value Added Covers	Tele Consultation, Wellness Program, Discount from Network Provider	Tele Consultation, Wellness Program, Discount from Network Provider, Health Check Up
Add-on Covers	Personal Accident Cover, Temporary Total Disablement. Health Check Up, Air Ambulance, Restoration of Sum Insured, Gullak (Guaranteed Cumulative Bonus), Maternity & New Born Hospitalisation Expense, Sarathi (Waiving off PED Waiting Period of Listed condition), Room Rent Modification, Surplus (Additional 100% of Sum Insured available from Day 1 for 1st Claim), Anant (Unlimited Sum Insured for hospitalisation related to Cancer, Heart, Stroke OR Major Organ/Bone Marrow Transplant), Deductible, Co-pay, Coverage for Non-Medical Items & Durable Medical Equipment	Personal Accident Cover, Temporary Total Disablement, Air Ambulance, Room Rent Modification, Surplus (Additional 100% of Sum Insured available from Day 1 for 1st Claim), Deductible, Co-pay, Pratiksha (Option to include waiting period on Specified Disease/procedure & Initial 30 days waiting period), Coverage for Non-Medical Items & Durable Medical Equipment,Pratiksha (Option to include 24 months waiting period towards Specified Disease/Procedure Waiting Period and 30 Initial Waiting Period)
Waiting Period	PED – 36 Months, Specific – 24 Months, Initial – 30 Days	No Waiting Period
Discounts	Lifetime Discount 2.5% Early Renewal Discount OR Standing Instruction Discount. Long Term Discount of 7.5% for selecting 2 Year Policy and 10% for 3 Year policy term. Family Discount of 10% on the premium for covering 2 members under same individual or Multi Individual Policy. 5% Website Discount 10% Employee Discount Short Term Discount 5% discount on first policy renewal premium. 10% Worksite Marketing Discount. Max up to 15% discount in lieu of commission. Website, Employee, Worksite, Discount in lieu of commission are mutually exclusive.	Lifetime Discount 2.5% Early Renewal Discount OR Standing Instruction Discount. Long Term Discount of 7.5% for selecting 2 Year Policy and 10% for 3 Year policy term. Family Discount of 10% on the premium for covering 2 members under same individual or Multi Individual Policy. 5% Website Discount 10% Employee Discount Short Term Discount 10% Worksite Marketing Discount. Max up to 15% discount in lieu of commission. Website, Employee, Worksite, Discount in lieu of commission are mutually exclusive.

 

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-hospitalization 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 Homeopathy. 

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. 

FAQs 

Q1. 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. 

Q2. 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. 

Q3. 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. 

Q4. 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.