Insurance Coverage in India: What’s Covered, What’s Not, and How to Get the Most Out of It

When you hear insurance coverage, the financial protection offered by a health or medical insurance policy to pay for care. Also known as health insurance, it’s meant to shield you from big medical bills—but in India, not all policies are created equal. Many people think their insurance will cover everything from heart surgery to mental health therapy, but that’s not always true. What’s included depends on the plan, the insurer, and even the hospital you choose. You could end up paying out of pocket for things you assumed were covered, like certain diabetes medications, follow-up care after knee replacement, or even specific types of anesthesia for dental implants.

One big gap in many policies is mental health, treatment for conditions like depression, anxiety, or post-surgery cognitive changes. Even though therapy and counseling are critical for recovery after heart surgery or dealing with chronic illness, many insurance plans in India treat mental health as optional. And then there’s Ayurvedic treatments, traditional healing practices like Panchakarma or herbal cleanses. Most insurers won’t touch them, even if your doctor says they help. Meanwhile, newer drugs like semaglutide for weight loss or diabetes are often excluded unless you have a premium plan. You need to read the fine print—not just the brochure.

Insurance claims, the process of asking your insurer to pay for services you’ve received are another minefield. A study from India’s Insurance Regulatory and Development Authority found that nearly 3 in 10 claims get delayed or denied because of missing paperwork, wrong hospital networks, or unclear diagnosis codes. Even if you’re eligible, if your hospital isn’t tied to your insurer, you’ll pay upfront and wait months for reimbursement. That’s why knowing your policy’s network hospitals matters as much as the coverage limit.

What you’re really buying isn’t just protection—it’s predictability. If you’ve had heart surgery, know that recovery timelines vary. Day 3 is often the worst, and your insurance might cover the hospital stay but not the follow-up rehab. If you’re managing diabetes, your policy might cover metformin but not the newer GLP-1 agonists that help with weight loss. And if you’re considering IVF or dental implants, you’ll need to check whether those are listed as exclusions. The best insurance coverage doesn’t just pay for emergencies—it helps you plan for the long haul.

Below, you’ll find real stories and breakdowns from people who’ve dealt with these exact issues—how they navigated claim denials, what they learned about policy limits, and which treatments actually made it through. Whether you’re worried about the cost of cancer treatment, the hidden fees after knee replacement, or whether your mental health visits are covered, the articles here cut through the noise and show you what’s really possible.