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List of diseases covered by health insurance in India

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It is important to note in Health Insurance that no policy terms and conditions provide the list of all diseases covered under the plan. All insurance plans only list out the diseases excluded under the respective plans.   know more »

It is safe to assume that all diseases/illnesses not excluded from the policy are covered under the insurance company’s health insurance plans. Some of the standard illnesses/diseases excluded from Health insurance plans in India include:

  • “AIDS” (Acquired Immune Deficiency Syndrome) and/or infection with HIV (Human immunodeficiency virus) including but not limited to conditions related to or arising out of HIV/AIDS such as ARC (AIDS related complex), Lymphomas in brain, Kaposi’s sarcoma, tuberculosis.
  • The abuse or the consequences of the abuse of intoxicants or hallucinogenic substances such as intoxicating drugs and alcohol, including smoking cessation programs and the treatment of nicotine addiction or any other substance abuse treatment or services, or supplies.
  • Treatment of Obesity and any weight control program subject to cover under benefit bariatric surgery.
  • Psychiatric, mental disorders (including mental health treatments); Parkinsons and Alzheimer’s disease;
  • Congenital external diseases, defects or anomalies;
  • Stem cell implantation or surgery; or growth hormone therapy;
  • Sleep-apnea
  • Charges related to peritoneal dialysis (CAPD), including supplies
  • Admission primarily for diagnostic and evaluation purposes only.
  • Venereal disease, sexually transmitted disease or illness;
  • Sterility, treatment whether to effect or to treat infertility; any fertility, sub-fertility or assisted conception procedure; surrogate or vicarious pregnancy; birth control, contraceptive supplies or services including complications arising due to supplying services.
  • Laser treatment for correction of eye due to refractive error;
  • Aesthetic or change-of-life treatments of any description such as sex transformation operations, treatments to do or undo changes in appearance or carried out in childhood or at any other times driven by cultural habits, fashion or the like or any procedures which improve physical appearance.
  • Plastic surgery or cosmetic surgery unless necessary as a part of medically necessary treatment certified by the attending Medical Practitioner for reconstruction following an Accident, Cancer or Burns.
  • All preventive care, vaccination including inoculation and immunisations (except in case of post- bite treatment and other vaccines explicitly covered);
One must refer to the policy terms and conditions of the opted insurance plan to ensure they are aware of the coverages and exclusions.

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