What Do Health Insurance Plans Cover and Should You Get One?

From hospitalisation and doctor visits to prescription drugs and emergency services, know more about health insurance plans that offer financial protection and access to vital medical care.

By URLife Team
12 Dec 2023

What might feel like sufficient health coverage today might not meet tomorrow's needs. Your dedication to your family's well-being drives the desire to shield them from unforeseen circumstances. This highlights the importance of assessing the necessary level of health insurance, especially when supporting your loved ones.


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What Does Health Insurance Cover?

A robust health insurance policy serves as a safety net for essential medical expenses, encompassing planned hospitalisations, emergencies, and non-hospital medical care. The extent of your health insurance should extend beyond mere coverage, providing comprehensive protection and a sense of security against potential financial strains.


1. Hospitalisation

This includes expenses related to inpatient care, surgeries, room charges, and other medical services received during a hospital stay.


2. Doctor Visits

Health insurance often covers visits to primary care physicians, specialists, and other healthcare providers for consultations, check-ups, and treatments.


3. Prescription Drugs

Many plans include coverage for medications prescribed by healthcare providers, helping offset costs for necessary drugs.


4. Preventive Care

Health insurance emphasises preventive services such as vaccinations, screenings, and annual check-ups to maintain overall health and detect potential issues early.


5. Emergency Services

Coverage extends to emergency room visits, ambulance services, and urgent care for sudden or critical medical needs.


Related story: 7 Reasons Why Getting Health Insurance Should Be A Priority In 2023


Types of Health Insurance Plans

Each type of health insurance plan offers unique benefits and caters to different needs. It's crucial to consider factors such as coverage, premiums, exclusions, waiting periods, and policy terms before choosing a health insurance plan to ensure it aligns with your specific requirements and financial capabilities.


Mediclaim Insurance

Mediclaim Insurance is a type of health insurance policy that covers medical expenses incurred by the insured individual due to illness, accidents, or hospitalisation. It reimburses hospitalisation expenses, including room charges, surgery costs, doctor's fees, and more, up to the sum insured. Mediclaim policies can be either individual or family floater plans.


Individual Coverage

Individual health insurance provides coverage to a single person against medical expenses arising from illness, accidents, hospitalisation, and other healthcare needs. The coverage is specifically tailored to the insured individual's health needs and age. The premium and sum insured are based on the individual's health risk profile.


Family Floater Coverage

A Family Floater Health Insurance policy covers the entire family (including the insured, spouse, children, and sometimes parents) under a single plan. The sum insured is shared among all family members. It offers flexibility as the total coverage amount can be utilised by any family member as needed.


Senior Citizen Coverage

Senior Citizen Health Insurance is designed specifically for individuals above a certain age bracket, usually 60-65 years and above. These policies address the specific health concerns and medical needs of senior citizens. They often cover age-related illnesses and provide higher sums insured with additional benefits like pre-existing disease coverage.


Unit Linked Health Plans (ULHP)

Unit Linked Health Plans combine health insurance coverage with investment opportunities. A part of the premium is allocated towards health coverage, while the remaining amount is invested in market-linked instruments like mutual funds. 


Critical Illness Plan

A Critical Illness Plan is a type of insurance that provides a lump sum amount to the insured upon diagnosis of a specified critical illness covered under the policy. This lump sum payment is made regardless of the actual medical expenses incurred. Common illnesses covered include cancer, heart attack, stroke, organ transplant, kidney failure, etc. The amount received can be used to cover medical expenses, loss of income, or any other financial obligations during the treatment period.


Personal Accident Plan

A Personal Accident Plan provides financial coverage in the event of accidental death, bodily injuries, or disabilities caused by accidents. It offers compensation in the form of a lump sum or a weekly benefit in case of temporary or permanent disability resulting from an accident. This coverage is separate from health insurance and can provide financial support for medical expenses, rehabilitation, or loss of income due to disability caused by accidents.


Hospitalisation Cash Benefit Plan

A Hospitalisation Cash Benefit Plan provides a fixed daily cash benefit to the insured for each day of hospitalisation due to illness or injury. Unlike regular health insurance that reimburses actual medical expenses, this plan provides a daily cash benefit, regardless of the actual expenses incurred. The insured receives this benefit for each day of hospitalisation, which can be used to cover miscellaneous expenses, including non-medical costs during hospital stays.


Related story: Ways To Cope With Mental And Physical Impact Of Financial Anxiety


The Importance of Having Health Insurance

The importance of health insurance extends beyond financial protection; it encompasses access to quality healthcare, preventive care, and overall peace of mind. It plays a pivotal role in ensuring individuals can navigate healthcare systems without the fear of exorbitant costs and helps promote a healthier and more secure future.


Provides Financial Protection

Health insurance provides a safety net against unexpected and often substantial medical expenses. It shields individuals from bearing the full brunt of high healthcare costs, offering financial security during times of illness or injury.


Access to Quality Healthcare

Having insurance facilitates access to better healthcare services. It ensures individuals can seek timely medical attention, consultations with specialists, and necessary treatments without facing significant financial barriers.


Aids Preventive Care

Health insurance encourages and often covers preventive services such as vaccinations, screenings, and regular check-ups. This proactive approach helps in early detection and management of potential health issues, promoting overall well-being.


Provides Peace of Mind

Health insurance alleviates the stress associated with medical emergencies. It offers the reassurance that necessary care is available without imposing a crippling financial burden, allowing individuals to focus on recovery rather than worrying about expenses.


Gives Tax Benefits

Under Section 80D of the Income Tax Act in India, individuals can claim deductions on the premium paid for health insurance for themselves, their spouse, dependent children, and parents. The deductions are available up to a certain limit, which varies based on the age of the insured individuals and the type of coverage. For individuals below 60 years, the maximum deduction is up to Rs. 25,000 for the premium paid for self, spouse, and dependent children. Additionally, an extra deduction of up to Rs. 25,000 is available for the premium paid for parents (below 60 years).


Related story: Types of Healthcare Clinics: How Can They Help Amid Tight Work Schedules


When Should You Get Health Insurance?

Choosing the appropriate time to acquire health insurance involves assessing personal circumstances, including age, health status, and employment situation. Determining the right time to acquire health insurance depends on various personal circumstances and understanding enrollment periods.


Consideration of Personal Circumstances

  • Age and Health Status: Securing health insurance becomes increasingly vital with age and potential health concerns. It provides crucial coverage and access to healthcare services when needed.
  • Employment Status: Evaluate if your employer provides health insurance benefits. For self-employed individuals or those without employer-provided coverage, securing individual plans is essential.


Understanding Enrollment Periods

  • Open Enrollment: Typically occurs annually and is the designated period to enrol in or modify health insurance plans. Missing this window might limit your options unless qualifying for a Special Enrollment Period.
  • Special Enrollment Periods: These are triggered by certain life events, like marriage, birth of a child, loss of other coverage, or relocation. They allow individuals to enrol or modify their coverage outside the standard enrollment period.
  • Qualifying Life Events: Major life changes—such as getting married, having a baby, or losing existing coverage—may qualify you for a Special Enrollment Period. It's crucial to understand these events as they impact when you can enrol in or change health insurance plans.


Related story: Future-proof Your Family: How Often Should You Schedule Regular Check Ups


Need all your wellness solutions in one place? A whole new world awaits just a click away.


The importance of health insurance extends beyond financial protection; it encompasses access to quality healthcare, preventive care, and overall peace of mind. It plays a pivotal role in ensuring individuals can navigate healthcare systems without the fear of exorbitant costs and helps promote a healthier and more secure future. This highlights how health insurance offers not only financial protection but also access to better healthcare, preventive services, and peace of mind during medical emergencies.




Meenakshi 14 May 2024

How to order medicines. I have valid prescription.


Meenakshi 14 May 2024

My refno. 630500-1-B


Meenakshi 14 May 2024

My name is Mrs. MEENAKSHI SUNDAR. I am subscribing to SBI health assist policy B. I have added my husband's name C.Sundar aged 82 years for purchasing medicines thro Apollo Pharmacy for diabetics. I also need medicines for diabetics. My no. Is 6305


Shashank Kumar Sharma 23 Apr 2024

I am S k Sharma, PF no.2030242, want to inform that they have charged from me 85% of the cost of medicine where as we exemployee has to pay only 33% as per our Sbi agreement. So, i will request our management to check the irregularity.


Basavaraja 15 Feb 2024

I am Basavaraja Murthy MM I am Basavaraja Murthy MM.Myhrms no.6123473. Sbi assist plan B .I am not getting urlife guest icon for ordering medicines. Kindly advise in this regard.


Madhav Dattatraya Sampgaonkar 19 Jan 2024

From sbi, wants to order medicine, how wants to order medicine to check valet balance and order


Laxma Reddy 18 Jan 2024

I am Laxma Reddy HRMS No 6315488 . SBI health Assist members are eligible for 73.5% (eg cost of medicine is 125 first 20% discount means 100. we have to pay 33.33% only. Rest of the amount to claimed in SBI. But bill is 174 instead 56 please check


Anjaneya Reddy 08 Jan 2024

Nice ????


Sravs 19 Dec 2023

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