Diseases Covered Under Health Insurance Policy

What is Disease-Specific Coverage under Health Insurance?

Disease-specific coverage under health insurance refers to a policy or benefit that provides coverage only for specific named diseases, rather than for all medical conditions. This type of coverage comes with a waiting period; coverage is guaranteed after the waiting period. 

What Does Health Insurance Cover in India?

Health insurance policies in India primarily cover hospitalisation costs (doctor fees, room rent, ICU charges), pre-hospitalisation (consultation charges, diagnostic tests, and medication charges), post-hospitalisation (follow-up visits), ambulance charges, OPD visits, daycare procedures, and advanced technology methods. 

Specific plans also offer additional benefits at an additional premium, such as an annual health checkup, a PED wait-period modification, and air ambulance coverage.  

Common Diseases Covered Under Health Insurance

Below are the types of diseases covered by most health insurance plans in India, subject to policy terms and conditions, and applicable waiting periods. 

Communicable Diseases

These illnesses are caused by infectious agents, like bacteria or viruses, and can spread from one person to another. Health insurance plans in India generally cover these diseases when hospitalisation or medical treatment is required. Common examples include dengue, malaria, typhoid, and COVID-19

Chronic Diseases

Chronic diseases are long-term medical conditions that require proper management, medication, and regular monitoring. Health insurance plans typically cover treatment expenses, typically after the applicable waiting period. Most common examples include diabetes, hypertension, asthma and thyroid disorders. 

Critical Illnesses

Critical Illnesses are defined as critical life-threatening conditions that involve high treatment costs and longer waiting periods. Health insurance policies provide coverage for medical expenses incurred in treating these conditions. Examples of critical illnesses include cancer, stroke, end-stage kidney failure and motor neuron disorder. 

Lifestyle & Degenerative Conditions

Lifestyle conditions include the type of diseases that develop due to lifestyle factors such as poor diet, lack of exercise, smoking, drinking and stress (obesity, heart disease and Type 2 diabetes). On the other hand, degenerative conditions are diseases in which cells, tissues, or organs gradually lose function (e.g., Alzheimer’s disease and osteoarthritis). 

Health Insurance for Pre-Existing Disease

A pre-existing disease is a medical condition for which medical advice, diagnosis, and treatment were received before the policy was purchased. Common pre-existing diseases include high blood pressure, diabetes, asthma, and heart-related conditions. These diseases generally require long-term care. 

Policyholders seeking coverage for pre-existing diseases must complete a 3-year waiting period. After the waiting period, expenses for hospitalisation and treatment are covered up to the sum insured. 

List of Slow-Growing Diseases in Health Insurance

Slow-growing diseases are covered as named ailments in health insurance. However, a waiting period of 2 years is applicable before claiming the policy. We, at Care Health Insurance, provide coverage for 14 ailments listed below: 

• Cyst 
• Hernia
• Tumor
• Cataract 
• Arthritis
• Piles/ Haemorrhoids
• Fissure 
• Knee Replacement 
• Kidney Stones
• Varicose veins
• Varicose Ulcers
• Alzheimer's 
• Parkinson's
• Breakage of bones 

Disclaimer: All plan features, benefits, coverage, and claims underwriting are subject to policy terms and conditions. Kindly refer to the brochure, sales prospectus, and policy documents carefully.

Diseases and Treatments Not Covered Under Health Insurance

Health insurance policies don’t cover certain medical conditions or treatments. These exclusions are common across most health insurance plans in India and are subject to the policy's terms and conditions. 

• Diseases that occur within the initial 30-day waiting period 
• Congenital Diseases
• Cosmetic treatments 
• Infertility treatments, including IVF
• Illness or injury arising from war, riots, or nuclear events
• Self-inflicted injuries

Disease Coverage Checklist

Before selecting a health insurance policy, key aspects of disease coverage should be considered. Use the checklist below to understand waiting periods, covered conditions, and exclusions: 

• Waiting periods applicable for named ailments and pre-existing conditions
• List of diseases covered under named ailments 
• Policy exclusions related to certain diseases or medical conditions 
• Network hospitals available for disease-related treatment