Insurance Coverage for Medical Treatments in India: What’s Covered and What’s Not

When it comes to insurance coverage, the financial protection offered by health plans for medical services and treatments. Also known as health insurance benefits, it determines what you pay out of pocket and what your insurer picks up. In India, this isn’t straightforward. Unlike in some countries, most standard health plans don’t automatically cover fertility treatments, weight loss drugs, or even certain types of surgeries unless you’ve paid extra for add-ons. Many people assume their policy covers everything — until they get a denial letter.

IVF insurance, coverage for in vitro fertilization procedures and related medications, is one of the biggest gaps. Only a handful of state-mandated plans in India offer partial IVF coverage, and even then, it’s often limited to one cycle. Most people end up paying ₹2.2 lakh to ₹3.5 lakh out of pocket. Meanwhile, Ozempic insurance, coverage for the diabetes and weight loss drug semaglutide, is hit or miss. Even if your insurer covers it for diabetes, they’ll often deny it for weight loss — despite the same drug being used. Express Scripts and other pharmacy benefit managers require prior authorization, and many claims get rejected without clear reasons. The same goes for weight loss medication insurance, coverage for drugs like Wegovy, Zepbound, or GLP-1 agonists. These aren’t seen as "essential" by most insurers, even though they’re FDA-approved and backed by clinical data.

What’s covered? Routine hospital stays, surgeries like knee replacements, and diabetes meds like metformin are usually included. But if it’s elective, expensive, or tied to lifestyle — think dental implants, IVF, or obesity drugs — you’re on your own. Some plans let you use HSA or FSA funds for these, but not all do. And if your claim gets denied, you can appeal — but you’ll need documentation, doctor letters, and sometimes legal help. This isn’t about luck. It’s about knowing your policy inside out, asking the right questions before treatment, and understanding that coverage doesn’t mean accessibility.

Below, you’ll find real guides from people who’ve been through this. From how to get Express Scripts to approve Wegovy, to which insurance plans actually cover IVF in 2025, to what to do when your claim for Ozempic gets turned down — these aren’t theory pieces. They’re battle-tested steps from real patients in India who figured out how to navigate the system. No fluff. Just what works.