Understanding what health insurance covers

employee health

It is a common saying that ‘Healthy Mind is a Healthy Body’. Mental health is closely related to physical health.

Having a healthy mind and body are the key factors that help a person to be his or her best. Prevention is better than cure.

But how much ever we take care of ourselves, there are chances that we become sick. Getting proper treatment at the proper time is very important in recovery. Sometimes finance comes as a roadblock in the way of getting proper quality treatment. That is when health insurance comes as a useful investment. Health insurance is gaining popularity in India. 

Many people take health insurance, often to get a tax benefit. They enroll in some plans without knowing what is covered under the plan. When an emergency comes, they get to know that some of the services they required were not covered under the plan. This makes them feel ‘cheated’ by the company. So, it is very important that one understands the coverage and other details before enrolling in a plan.

What is Health Insurance?

Health insurance is an agreement between You and the Health insurance company. The agreement is that the company will pay some or several of your expenses related to medical procedures, drugs, doctor visits etc. All these for a premium that you pay to the company. Premium can be paid monthly, quarterly or yearly.

There are many companies providing health insurance in India. While some companies offer health insurance along with other types of insurance like life and vehicle, Star Health Insurance plans specialize in health insurance.

Factors to Consider while Buying Health Insurance

First, we need to analyse our needs. Even though we may not be able to predict our future, an analysis will help us to understand what our present and future medical needs could be. The analysis should include our present health condition, personal habits, and family history. Then the important factor to consider is how much premium can we afford to pay. Based on that different plans offered by different companies should be compared. Then a plan that suits us best should be chosen.

Sum Insured

Benefits vary based on the premium and the sum insured. Sum insured is the maximum money the company will pay a year to the insurer. If the claim amount goes beyond the sum insured, the additional amount should be borne out of pocket.  It goes without saying that for higher premiums better coverage and sum insured will be obtained. On expiry, the policy can be renewed. Some policies from Star Health Insurance offer 100% increase in the sum insured if there were no claims during a period.

Network of Hospitals

The network of hospitals is another important point to be considered while enrolling in a plan. It is wise to enroll in a plan offered by companies with a wide network. Star Health Insurance has a network base of more than 8400 hospitals across India.

If a policy with Cashless benefit is taken, treatment can be obtained from the network hospitals without paying anything out of pocket. Star Health Insurance offers many Cashless hospitalization policies. If the policy is without Cashless benefit, treatment can be taken from any of the network hospitals and the amount should be paid. Then claim should be submitted with all the required documents. The amount will be approved based on the policy.

Individual or Family Floater Plan

Policy can be taken either for the individual or for the entire family. A wide variety of services are offered for varying premium amounts. Some policies cover both inpatient and outpatient expenses. In that case hospitalisation, doctor visits, prescription drugs, day care procedures, ambulance, pre-hospitalisation and post hospitalisation expenses for a few days will be covered. Star Health Gain Insurance Policy from Star Health Insurance is an example.


There are also policies that cover only hospitalization. In most of the individual policies, Preventive health check-ups are covered. This includes scans, pap smear, mammogram, colonoscopy etc. These kinds of policies are gaining popularity nowadays.

If you don’t want to keep track of separate policies for the family members, a family floater policy is the best option. It is a single policy that covers all the family members. The sum insured will be higher for these policies. This has an advantage that in case a family member is sick and hospitalised, that year’s entire sum insured can be used for that member.

Many such policies cover emergency ambulance, maternity, new-born, dental and ophthalmic expenses. Star Comprehensive Insurance, Family Health Optima and Star Family Delite Insurance Policies from the Star Health Insurance are very good family floater plans. They also cover personal accidents.

You can also Get Senior Citizen Plans

There are also plans specific to senior citizens. Star Health Insurance offers such policies. They cover pre-existing diseases and offer more sum insured. In addition to the coverage discussed above in other plans, these policies also cover for specific diseases like cataract. In some cases, attendant charges are covered for a few days after hospitalization.

Check out Critical Illness Plans

There are plans available for people with specific illnesses. There are policies for people diagnosed with cancer. Often the cancer treatment expenses are so much, that many are reluctant to take advanced treatments. Health insurance gives those people many advantages. Surgery, day care procedures, screenings, treatments like chemotherapy, radiation etc. are covered under these plans.

Similarly, a diabetes care policy covers expenses related to diagnostic tests and all the diabetic related treatments. Diabetics Safe Insurance Policy from Star Health Insurance is a good one which also covers for kidney transplant surgery and dialysis.

There are policies available for cardiac patients also. With an increased number of people being diagnosed with cardiac problems every year, many are opting for these policies.

Star Health Insurance also offers some unique policies. For example, there are policies designed specifically for Autistic kids and for HIV positive patients. There are also policies exclusively for accidents.

With a huge number of companies offering health insurance, it is very important to choose wisely. All the details regarding the coverage, premium, terms, and conditions, including those in fine print should be read carefully before investing in a policy.