Insurance Cost in India: What You Really Pay for Health Coverage

When you think about insurance cost, the total amount you pay for health coverage including premiums, deductibles, and out-of-pocket expenses. Also known as health insurance expense, it’s not just what shows up on your bank statement—it’s what you end up paying when you actually need care. Many people in India assume their insurance covers everything, only to find out later that key treatments—like IVF, weight-loss drugs, or even certain orthopedic surgeries—are either partially covered or denied outright.

Insurance coverage, the specific medical services and treatments your policy agrees to pay for. Also known as policy benefits, it’s where things get messy. Take Zepbound or Ozempic: these weight-loss medications are FDA-approved, widely used in clinics, and yet most Indian insurers won’t touch them. Why? Because they’re classified as "cosmetic" or "non-essential," even though they treat obesity—a condition linked to diabetes, heart disease, and joint failure. The same goes for some mental health therapies. CBT and DBT are proven to help with depression and anxiety, but many plans only cover a few sessions, if any. And when you need a knee replacement or rotator cuff repair, your insurance might pay for the surgery but not the follow-up physiotherapy, leaving you with thousands in hidden costs.

Insurance denial, when a claim is rejected by the insurer, often due to technicalities, pre-existing condition clauses, or lack of pre-authorization. Also known as claim rejection, it’s one of the biggest surprises for patients. You’re not alone if you’ve been told your full body blood test isn’t covered because it’s "routine," even though it caught your early-stage diabetes. Or that your liver function test was denied because you didn’t have symptoms yet. Insurers often wait until you’re sick to start asking questions. The truth? Most denials happen because of paperwork errors, not medical necessity. But that doesn’t make it easier when you’re trying to recover from open-heart surgery and can’t afford the meds your doctor prescribed.

What you’ll find below isn’t theory. These are real stories from people who’ve fought insurers over IVF timelines after childbirth, battled denials for dental implants due to bone loss, or paid out of pocket for mental health care because their plan didn’t list therapy as essential. We’ve pulled together posts that break down exactly what’s covered, what’s not, and how to push back when your claim gets turned down. No fluff. No jargon. Just what you need to know before you sign a policy—or before you walk into a hospital.