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Diseases Covered Under Health Insurance

Diseases Covered under Health Insurance Policy

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Sunita, a working woman from Delhi, had recently purchased an individual health policy. Within a few months, she underwent a dental treatment procedure and decided to claim on her policy. When she contacted her insurer, she realized that the medical condition for which she made a claim was on the list of diseases covered under health insurance.

While health insurance offers comprehensive coverage for expenses that go beyond hospitalization; mediclaim policies, on the other hand, provide cover for the hospitalization-related expenses for a specified time limit. Despite this difference, health policies are highly beneficial in terms of a predefined sum insured. However, when buying such a policy, it is essential for the policyholder to thoroughly read the policy details to know the diseases covered under health insurance and diseases not covered under health insurance.

List of Diseases Covered under Health Insurance

The list of diseases covered under health insurance depends on the type of plan chosen by a person. However, health insurance policies generally cover the following medical conditions:

Accident-related Expenses

The coverage for treatment for injuries caused by accidents is provided by health policies. Accidents are medical emergencies that require immediate hospitalization. So, the expenditure incurred by an individual during hospitalization is covered under health insurance policies, subject to policy terms and conditions. Moreover, cashless health insurance is a feature available with such policies wherein the insured person can avail treatment at any of the network hospitals of the insurer and opt for a cashless claim facility.


Coronavirus battle is still on for everybody! But, with vaccination and health insurance, you can stay protected. Thankfully! Our indemnity-based health insurance policies cover coronavirus treatment as well. You can enhance the policy coverage with COVID Care and Care Shield add-ons. These add-ons include hospitalization, medicines, home quarantine expenses, consumable items like gloves, masks, etc. With extensive policy coverage, you can keep yourself and your family at bay from the lethal virus.


Undoubtedly medical advancement brings new hopes to many. Cancer patients with timely treatment getting recovered from this deadly disease. However, the treatment cost is skyrocketed, but the one good thing is that the health insurance policy also covers cancer treatment expenses. Whether it is hospitalization, medication, chemo, or radiotherapy, policyholders get complete coverage to avail timely treatment for various stages of cancer.

Diabetes, High BP & High BMI

Diabetes, high BP, and high BMI are diseases that require prolonged treatment, creating a financial burden for many. Thus, our health insurance works as a financial cushion. It covers the treatment expenses related to these ailments and their direct complications. People who have diabetes, or high bp or high BMI as pre-existing diseases can also get the coverage after completing the waiting period of 24 months.


Health insurance brings a big sigh of relief for people suffering from life-threatening diseases like HIV/AIDS. They can also get a policy that covers their hospitalization and treatment expenses. From daycare treatment, domiciliary hospitalization to ambulance expenses, AYUSH treatment policyholders will get comprehensive coverage that helps them to get the best medical facilities and live healthy lives.

Critical Illnesses

Due to a sedentary lifestyle, work stress, bad eating habits, alcohol, etc., lifestyle diseases take a toll on health. If not treated timely, it can be fatal. But, as medical inflation is skyrocketing, it is not easy to get the treatment until you have health insurance. Our critical illness insurance covers 32 types of critical illnesses. You can get it at a low premium with high coverage.

Heart Ailments

Your heart is the most vital organ of your body, and that's why you should keep a regular check on how it beats. We have health insurance for heart patients that covers different cardiac problems and pre-existing ailments. You will get an annual cardiac health check-up, AYUSH coverage, and a lot more under this policy.

Specific Diseases

Generally, every health policy has a waiting period of 30 days from the date of policy issuance. However, some diseases such as Arthritis, Osteoporosis, Gout, Spinal Disorder, Joint Replacement, Ligament Repair, Cataract, Hernia, etc., have a specific waiting period of 24 months. These are covered under the policy, but policyholders can file a claim after completing the waiting period.

Exclusions - List of Diseases Not Covered Under Health Insurance

Medical conditions/treatment/procedures that are not covered under health insurance plans are the policy exclusions. The list of diseases not covered under health insurance are:

  • Any diagnosis of diseases / undergoing of surgery/occurrence of an event, whose signs or symptoms first occur within 30 days of Policy Period Start date.
  • Expenses attributable to self-inflicted injury (resulting from suicide, attempted suicide).
  • Expenses arising out of or attributable to alcohol or drug use/misuse/abuse
  • Treatment arising from or traceable to pregnancy and childbirth, miscarriage, abortion, and its consequences
  • Congenital disease
  • Tests and treatment relating to infertility and in vitro fertilization
  • War, riot, strike, nuclear weapons induced hospitalization

The list of diseases covered under health insurance varies based on policy and its coverage. Therefore, it is wise to carefully read the policy terms and conditions to know what diseases are covered and not covered under health insurance. It will help you to get the best healthcare facilities and hassle-free claim settlements.


Disclaimer: The above information is for reference purposes only. For more details about the health insurance plans, please refer to the sales prospectus, policy terms, and conditions.

^^Number of Cashless Healthcare Providers till 25th March 2022.

^Annual premium for product 'Care' and 'Care Shield (add on)' is Rs. 6160/-(excl. GST) for 1 adult falling under the age bracket 05-24 years, 1 Adult 18-24 age group 3 Yr with NCB Super (Add-on).

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