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What Insurance Covers and What It Does not: A Beginner’s Guide

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Every one of us has faced unexpected events in life, whether it’s a fender bender on the way to work or a sudden illness that requires a hospital stay. These unforeseen events can lead to unexpected expenses, which can be ...

Every one of us has faced unexpected events in life, whether it’s a fender bender on the way to work or a sudden illness that requires a hospital stay. These unforeseen events can lead to unexpected expenses, which can be heavy on the pocket. That’s where insurance comes in, providing a safety net to help cover such costs.

But not all insurance policies are created equal. Different policies cover different events and come with their own sets of terms and conditions. The key is to understand what’s covered under your policy and what’s not. This article aims to shed light on this very topic, providing beginners with a clear understanding of the fundamental principles of insurance coverage.

The Basics of Insurance Coverage

What is Insurance Coverage?
At its core, insurance is a contract (often called a policy) between an individual or entity and an insurance company. The individual pays a certain amount of money called a “premium” at regular intervals, and in return, the insurance company promises to cover specific financial losses or responsibilities that may arise from certain events.

The Principle of Risk-sharing and Premiums
Insurance works on the principle of risk-sharing. Imagine a group of 1,000 people. Not everyone will face a crisis at the same time. So, each member contributes a small amount to create a pooled fund. If one person faces a crisis, the pooled fund can help cover their losses. The amount each member pays into the pool is their “premium.”

Premiums are calculated based on the risk associated with the event the insurance covers. For instance, if you’re insuring a brand-new sports car, you might pay a higher premium than if you were insuring a 10-year-old sedan. This is because the sports car, being more valuable and statistically more likely to be in an accident, represents a higher risk to the insurance company.

Common Types of Insurance and Their Coverage

Health Insurance
One of the most vital insurances for individuals, health insurance covers the costs associated with medical care.

  • Covered:
    • Routine Check-ups: Annual health screenings and preventive tests.
    • Emergency Treatments: Any immediate treatments required after sudden illnesses or accidents.
    • Surgeries: Medical procedures deemed necessary by a medical professional.
    • Prescriptions: Medications prescribed by a doctor.
  • Not Covered:
    • Elective Cosmetic Surgeries: Procedures like facelifts or tummy tucks which are not medically necessary.
    • Brand-name Drugs: When equivalent generics are available at a lesser cost.
    • Treatments Not Deemed Medically Necessary: Experimental treatments or those not recognized as standard care.

Car Insurance
For those who own vehicles, car insurance provides coverage against various risks on the road.

  • Covered:
    • Damages from Accidents: Depending on your policy type, it can cover your vehicle’s damage, the other party’s vehicle, or both.
    • Theft: If your vehicle is stolen.
    • Natural Disasters: Events like floods, hurricanes, or hailstorms.
  • Not Covered:
    • Regular Wear and Tear: Gradual deterioration due to regular use.
    • Driving Under the Influence: Damages incurred while the driver is intoxicated.
    • War or Nuclear Risks: Most policies exclude damages from acts of war or nuclear reactions.

Home Insurance
Protecting our abode, home insurance covers various risks associated with homeownership.

  • Covered:
    • Natural Disasters: Damages from events like earthquakes, tornadoes, or fires.
    • Theft: Protection against burglaries or thefts.
    • Liability: If someone gets injured on your property and you’re held responsible.
  • Not Covered:
    • Intentional Damage: If damage is caused intentionally by the homeowner.
    • Mold: Some policies might not cover mold damage, especially if it’s due to negligence.
    • Neglected Maintenance: Damages arising from poor maintenance, like seepage from not repairing a leaky roof.

Factors Influencing Coverage Limits

The deductible is the amount you pay out-of-pocket for a covered event before your insurance kicks in. For instance, if your car repair costs £500 and your deductible is £200, you pay the £200, and your insurance pays the remaining £300. Typically, a higher deductible means a lower premium, but it also means higher out-of-pocket costs in case of a claim.

Policy Limits
Every insurance policy has a limit, which is the maximum amount the insurance company will pay for a claim. If your claim exceeds this limit, you will be responsible for the difference. For example, if your policy limit for home damages is £100,000 and the damages amount to £120,000, you would need to pay the extra £20,000.

Exclusions are specific conditions or situations where the insurance won’t provide coverage. It’s essential to know these exclusions, so you’re not caught off guard when something isn’t covered. They can be events like acts of war, nuclear hazards, or specific medical procedures.

Importance of Reading the Fine Print

Whenever you’re considering an insurance policy, you’ll be presented with a policy document. This isn’t just a formality; it’s a crucial piece of information that you should review in detail. Here’s why:

Understanding Your Coverage
While you might have a general idea of what your insurance covers, the policy document will list out in detail what’s included and what’s not. It will explicitly state the scenarios under which you can make a claim and when you can’t.

Spotting Potential Exclusions
As mentioned earlier, exclusions are specific instances when your insurance won’t pay out. By reading the fine print, you can become aware of these exclusions and plan accordingly. This might involve getting additional coverage or even reconsidering if the policy is right for you.

Being Aware of Your Responsibilities
Insurance is a two-way street. While your insurer has obligations to you, you also have responsibilities. The fine print will state any actions you need to take (or avoid) to ensure your coverage remains valid.

Avoiding Surprises
Few things are more frustrating than thinking you’re covered, only to discover during a claim that you’re not. By understanding the nitty-gritty of your policy, you can avoid unpleasant surprises.


Understanding insurance might seem daunting at first, especially with the plethora of terms and conditions that come with a policy. However, taking the time to educate yourself can save you a lot of hassle and money in the long run.

Insurance is more than just a monthly or annual payment; it’s a commitment to protecting yourself, your loved ones, and your assets. By knowing what’s covered and what’s not, you’re not just safeguarding your financial well-being; you’re also ensuring peace of mind.

Always consult with insurance professionals when in doubt, and remember: insurance isn’t about expecting the worst but being prepared for anything that life throws your way.


What is an insurance premium?

An insurance premium is the amount you pay to an insurance company in exchange for coverage. It can be paid monthly, quarterly, or annually, depending on the policy terms.

Are all insurance policies the same?

No, insurance policies vary based on the type of coverage, the insurance provider, and the specific terms and conditions outlined in the policy. It’s essential to read the fine print to understand what you’re getting.

Can I adjust the coverage in my insurance policy?

Yes, most insurance companies allow you to adjust your coverage levels, which can affect your premiums. Always consult with your insurance agent before making changes to ensure you understand the implications.

Are natural disasters covered by home insurance?

Coverage for natural disasters varies by policy. Some home insurance policies might cover events like fires and storms, but not floods or earthquakes. If you’re concerned about specific natural disasters, ensure they’re included in your policy or consider additional riders.

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