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

When it comes to insurance coverage, the financial protection you get for medical expenses under a health plan. Also known as health insurance benefits, it’s the difference between paying out of pocket and having a company cover part—or all—of your care. In India, this isn’t just about hospital bills. It’s about whether your Wegovy, a weight-loss drug prescribed for obesity and type 2 diabetes is covered, if your IVF treatment, a fertility procedure involving egg retrieval and embryo transfer gets reimbursed, or if your prescription coverage, the portion of drug costs paid by insurance includes newer medications like Ozempic. Most people assume insurance means full protection. It doesn’t. It means you need to know the fine print.

What gets covered depends on your plan type—government schemes like Ayushman Bharat, employer plans, or private insurers. But even within those, there are big gaps. For example, many plans won’t touch weight-loss drugs unless you meet strict BMI and diabetes criteria. IVF is often excluded entirely, or capped at one or two cycles. Even routine treatments like knee injections or physical therapy after joint surgery can be denied if they’re labeled "experimental" or "not medically necessary." And don’t assume your doctor’s recommendation is enough. Insurers use their own rules, often based on cost, not clinical need. You might need pre-authorization, medical records, or even a second opinion just to get approved. That’s why so many people end up paying thousands out of pocket—even when they think they’re insured.

But here’s the thing: coverage isn’t always fixed. You can challenge denials. You can find plans that include more. You can learn what to ask before signing up. The posts below show real cases—like how someone got Wegovy approved after three rejections, why IVF coverage varies wildly between states, and what bone and joint tests insurers actually pay for. You’ll see what doctors in Bangalore, Mumbai, or Delhi are telling patients about insurance hurdles. You’ll find out who qualifies for Ozempic under insurance, what paperwork you need, and how to avoid common mistakes that lead to denied claims. This isn’t theory. It’s what people in India are actually dealing with right now. And if you’re paying for care yourself, you need to know how to change that.