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10 Common Exclusions in Health Insurance Policies you should know about
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Exclusions in your health policy that you should know

The popularity of health insurance is sky high because customers have understood the importance of purchasing health insurance plans to lead a wholesome life. While buying a health insurance policy, customers often get tempted by its coverage. Customers give priority to those health insurance plans that offer unique coverage at a reasonable price. The eminent health insurance companies mention the inclusions in the policy so that customers can understand coverage while purchasing health insurance online. The coverage may vary from one insurer to another, but most insurers often define a set of inclusions and exclusions while designing their policies for the customers.

When a customer has decided to buy health insurance online, he/she must go through the details of the policy before investing a single penny. Most insurance companies already mentioned the exclusions clearly, so that no claim is issued for the exclusion lists. Being a meticulous person, a customer should read all the inclusions and exclusions for a hassle-free claim process. You should be very careful and smart while purchasing health insurance plans; else, you may end up with a nasty surprise in the future. Though most popular health insurance plans cover most diseases/ailments, some health conditions are still excluded. These are known as health insurance exclusions.

List of diseases not covered under health insurance policies

There are certain ailments for which the insured policyholders don’t get any reimbursement from insurance companies. Here, we are going to mention a list of diseases that are excluded from health insurance policies by most insurers.

  1. Pre-Existing Diseases
  2. Abortion and Pregnancy Expenses
  3. Cosmetic Surgeries, including Dental Treatments
  4. Diagnostic Expenses
  5. Health Supplements
  6. Injuries caused because of suicidal attempts
  7. Vision and Hearing
  8. Diseases due to alcohol consumption
  9. Alternative Therapy
  10. Permanent Exclusions

 

1. Pre-Existing Diseases

Pre-existing ailments (heart disease, kidney disease, diabetes, cancer, etc.) are excluded from your purchased health policy coverage. But, you can claim for these diseases after a certain waiting period decided by the insurance company. Depending on the insurance company, this waiting period can be 2 to 4 years. For the pre-existing conditions, the policyholders don’t receive any reimbursement or compensation before the waiting period. Thus, it would be a prudent decision if you purchase health insurance early so that your waiting period gets over quickly for pre-existing conditions.

2. Abortion and Pregnancy Expenses

Many health insurance policies don’t offer coverage for the cost of childbirth, maternity, and pregnancy. Similarly, infertility treatment and abortion costs are also not covered under these health insurance policies. However, by purchasing an add-on rider or separate maternity plan, you can get covered for the expenses of maternity and childbirth.

3. Cosmetic Surgeries, including Dental Treatments

These days, many people are opting for cosmetic surgeries to uplift their appearance, personality, and self-esteem. Any kind of cosmetic treatment is not covered by health insurance policies. So, if you are planning for a cosmetic treatment, you need to bear the entire expenses of the surgery. But if you need cosmetic surgeries in case of an accident, then some insurance companies may compensate you for the treatment. Similarly, all dental treatments are excluded from health insurance coverage except required due to an accident.

4. Diagnostic Expenses

Imaging or other laboratory tests conducted frequently to detect a disease/ailment can be expensive and will certainly burn your pocket. But no health insurance policy covers the cost of these tests. But suppose the tests show a positive result for any illness or injury, and you need to be hospitalized for treatment. In that case, it will cover the hospitalization and treatment costs.

5. Health Supplements

Any health insurance coverage does not cover health supplements like pills or protein shakes. But if the physician recommends these to combat an illness at the time of hospitalization (as a part of the treatment), then some insurers can bear the cost.

6. Injuries caused because of suicidal attempts

A health insurance policy does not cover any kind of self-injury or suicide attempt. Therefore, if the policyholder tries to hurt himself/herself consciously or intentionally, then he/she won’t get any compensation from the insurance company.

7. Vision and Hearing

If you need to purchase any product for your vision or hearing loss, this won’t be covered by any health insurance policy. But if you require hospitalization due to vision or hearing impairment, the insurance company will give you compensation for your treatment.

8. Diseases due to alcohol consumption

If you develop diseases due to unrestrained consumption of alcohol or any other substance injuries, then your condition won’t be covered by any health insurance policy. Ailments like liver damage due to excessive consumption of alcohol are also not covered by a health insurance policy. The premium amount is higher for smokers or tobacco users because they are more susceptible to life-threatening diseases like cancer, stroke, lung diseases, etc.

9. Alternative Therapy

Some insurance companies in India offer hospitalization coverage of ayurvedic and homeopathy treatment. But most insurers don’t offer coverage for alternative treatment methods like acupuncture, naturopathy, magnetic therapy, etc.

10. Permanent Exclusions

War injuries, HIV, congenital diseases, etc., are permanent exclusions from health insurance plans. So, ask your health insurance companies about exclusions before investing a single penny.

 

Diseases covered under Mediclaim Policy 

Let’s take a look at some of the diseases covered by health insurance policies.

  • Accidental-related expenditures
  • COVID-19
  • Cancer
  • Diabetes, high blood pressure, and high BMI
  • Critical illnesses
  • Heart-related diseases
  • Specific diseases

 

Does medical insurance cover medicines?

Most health insurance companies will offer coverage for the cheapest variety of medicine. But if your doctor prescribed expensive medicines for a medical reason, the insurance company may reimburse the medicine.

If you make a claim for the exclusions mentioned above, your claim will certainly get rejected by insurance companies. Thus, before making any commitment, read your health insurance policy carefully and ask the insurer in case of any doubt or confusion. To make your claim process hassle-free, you should have adequate knowledge about the exclusions of your health policy.

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