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SMC Insurance Brokers Pvt. Ltd.
Parsvnath Metro Mall, Near Pratap Nagar Metro Station, Pratap Nagar, New Delhi-110007
Registration No: 289, Registration Code No: IRDAI/DB-272/04/289, Valid till: 27/01/2026, License category: Direct Broker (Life & General), CIN: U66000DL1995PTC172311
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Health Insurance Benefits
Tax Benefits
u/s 80 (D)
Cashless
Treatment
Free Annual
Health Check up
Health Insurance in 2 Mins
Health Insurance Benefits
Tax Benefits
u/s 80 (D)
Cashless
Treatment
Free Annual
Health Check up
What Type Of Costs Are Covered Under Health Insurance?
Monisha is a regular fitness and yoga practitioner. Since she was certain that no illness would affect her, she didn’t buy a health insurance policy. One fine morning, she suddenly developed severe pelvic pain along with fever. She visited a doctor who performed a CT scan and diagnosed her with cervical cancer. Her treatment included surgery and chemotherapy, costing around Rs 10 Lakhs (including ICU charges, room rent, etc). She had no choice but to use her savings and sell her car to take care of the costs.
If she had bought Health Insurance for herself by paying affordable premiums per year, she wouldn't have had to deal with such a financial strain in this emotionally draining situation.
Health insurance covers the costs for medical hospitalisation expenses arising out of an illness or injury. The first thing you should do before buying health insurance is to make sure you know what is covered under it - so you'll know what to expect in times of need.
Coverage Provided Under Health Insurance
The following are the types of costs covered under Health Insurance-
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Pre-Hospitalisation Costs
You may incur costs related to tests or consultations before undergoing treatment or getting admitted to the hospital called pre-hospitalizations costs. These costs are covered by Health Insurance. Most health insurance plans cover pre-hospitalization costs for 30 to 90 days.
Pre-hospitalization costs include -
Blood tests
X-rays
OPD consultations fees
Diagnostic tests like ECG, EEG
Urine test, etc.
For example: Lekha has health insurance with a sum insured of Rs 10 lakhs. She gets mild chest pain, for which she consults a doctor. He advises her to undergo an ECG to check the condition of her heart. After examining the results, the doctor told her she had some complications and would require hospitalisation for 2-3 days. The ECG, any other tests, room rent, medicines, consultation fees, etc. shall be covered by her health insurance policy.
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In-Patient Treatment Costs
Being admitted to a hospital comes with certain hospitalisation expenses. These may exceed your budget and drain your funds. However, Health Insurance covers hospitalisation costs. In order to be eligible for a claim, you must be hospitalised for at least 24 hours.
Here are some of the hospitalisation expenses covered by health insurance -
Medical treatment expenses
Room rent
ICU charges
Surgery cost
Doctor consultation fees
Oxygen supply
Blood supply
Medicine costs, and so on.
However, there is an exception to the rule. It will be discussed in the next point.
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Day-Care Treatment Expenses
Some surgeries or treatments don't require you to stay overnight in the hospital (more than 24 hours). A health insurance policy covers these too.
These treatments include -
Gallbladder removal
Hernia
Chemotherapy
Cataract
Dialysis, etc
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Post-Hospitalization Costs
Health insurance also covers the expenses that you incur after you are discharged from the hospital. Typically, these plans cover post-hospitalization costs for 60 and 180 days.
The following expenses are covered under this category -
Regular check-up cost or follow up visits to your doctor
Diagnostic tests such as colonoscopy, ECG, etc.
Rehabilitation costs
Physiotherapy sessions costs, and so on.
For example: Madhav has health insurance with a sum insured of Rs 5 lakhs. He underwent knee surgery and the surgery costs are approximately Rs 2 lakhs. To keep an eye on the surgical wound, the doctor scheduled fortnightly medical appointments. His health insurance shall cover the surgery costs and the follow-up consultation charges.
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Organ Donor Hospitalisation
Many health insurance plans also cover the hospitalisation and surgical costs incurred by the organ donor during an organ transplant surgery. If this type of coverage is not provided under the plan, the expenses incurred by the organ donor during the period of hospital stay including the room charges, surgery costs, medicine costs, etc. shall need to be paid from your end.
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Domiciliary Hospitalisation
If you are not in a condition to be moved to the hospital due to the illness or injury or if there are no hospital beds available, you can receive treatment in the comfort of your home. This is called Domiciliary Hospitalisation. Most health insurance plans cover all costs associated with such home care. A registered physician shall supervise the domiciliary treatment, and a paramedic or nurse shall be on hand all the time to monitor you.
For example, Vimal has a health insurance policy with a sum insured of Rs 5 lakhs. One morning, he was cleaning his house when he slipped and fell from the stairs. He broke his right leg and passed out. His brother called a doctor and explained the situation. The doctor advised him not to take Vimal to the hospital as any further movement could worsen the fracture. So, he arranged for the entire treatment to be administered at home. In this case, the complete domiciliary hospitalisation costs including the medications, shall be covered by Vimal's health insurance.
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Wrapping Up!
Therefore, these are the expenses covered by Health Insurance. Before investing your money, be sure you are aware of what kind of coverage the policy offers. Take some time to read the policy wordings carefully - to avoid any unpleasant surprises later.
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Our Customers' Stories
Sharing the experience of happy and satisfied customers with you.
Sameer Yadav
I was searching for investment plan but I couldn't find it, then I got the call from SMC insurance and they aligned a call with Ishita Sharma as point of contact (POC) for all my queries and she explain me very well. Ishita explain me all investment plan with advantage and disadvantage, I really appreciate her. Ishita always enthusiast towords work and ready to answer all my questions .I have taken two policies ( HDFC click to invest) plan with 15k premium per month. I always recommend SMC insurance to all, for better life and happy retirement with huge health and wealth. Thank You SMC insurance for your best service. Special thanks to Ishita for E2E help and endless support, you did fabulous work. Show More
Dheeraj Bhatia
I am associated with SMC insurance since 2011 and found them to be most ethical, trustworthy and highly responsive. Some of my precious policies done thru other agencies are still running on SMC’s advice. That is a strong testimony to their customer-centric approach. I am glad to be associated with SMC and strongly recommend their services to all concerned. Wishing the very best to Team SMC !Show More
Jyoti Sharma
We were fortunate enough to have selected SMC as our Health Insurance Broker for they have been very helpful in resolving our queries related to health insurance. I would like to cite two examples where SMC's role has been very crucial. One was when payment for cashless hospitalization was not coming through as the insurance company was taking undue longer time to approve the Hospital Bill. It was then I talked to Neha and it was she who through her contacts in the Insurance co. facilitated and expedited the approval for payment of hospital bill. Second was very recently when the Insurance co. had proposed a top up "Enhancer" policy for our existing policy. When I talked to Neha she immediately told me not to take this policy being offered without any medical test as it will not be beneficial to us and may create problem later on account of recent hospitalization. If I had I not consulted Neha, I would have into a big trouble with the insurance co. These two instances speak very high of sincere advice and timely help rendered by the SMC Staff, Ms. Neha Khanna which helped us a lot in time of need.Show More
Sumit Khanna
Hi, I am Sumit here, purchasing insurance policies from SMC for almost 8 years. Would like to recommend this company to other customers because they are taking care of my insurance broking services in a fabulous way. I would like to extend my gratitude and thanks to policy servicing and also insurance claim backend services. They have rendered fantabulous services for me and would like you guys to definitely go and rely on them for all your insurance needs.Show More
Kishor Kumar Bijlani
My experience with SMC Brokers is excellent. They provide support from the beginning till end i.e from issuance of insurance policies till settlement of claims. They explain very nicely various provisions relating to Insurance Policy also facilitate settlement of claims with Insurance Companies. Show More
Megha Singhal
I have purchased HDFC policy from SMC Insurance with the help of Harsh Sharma. I have got the satisfactory services from SMC Insurance. Thank you SMC Insurance.Show More
