11 Diseases Not Covered Under Health Insurance Policy
Avinash and Tania have been married for four years and have decided to start parenthood. Tania has been diagnosed with some infertility complications and her gynecologist recommended surgeries. Since they have a health insurance policy, Tania started her treatment from one of the top-most hospitals in India. But Tania was disappointed when she discovered that her insurance company denied the claim for her infertility treatment. The couple had no other option except to pay off the bills from their end. When enquired, Tania came to know that infertility treatment belongs to the insurance company’s exclusion and thus, she was not eligible for the claim.
To avoid the pain of rejection, every policyholder should know the list of diseases that are not covered by the insurance company. Don’t make any commitment before checking the list of diseases not covered under health insurance in India.
Here, we are going to discuss the names of diseases that are not covered by a health insurance policy. These conditions are known as health insurance exclusion.
What is covered in health insurance?
Let’s take a look at some diseases covered in health insurance:
- Heart diseases
- Kidney problems
- Liver problems
- High Blood Pressure
- Accident related Hospitalization
These are common diseases in India that are covered by most health insurance policies. Now, COVID-19 cases are rising manifolds, thus, insurance companies are offering standalone COVID-specific insurance policies like Corona Kavach, Corona Rakshak, etc. to their customers.
11 Diseases not covered under Health Insurance
- Cosmetic Surgeries: Cosmetic treatments like Botox, liposuction, implants, and body contouring are not included under a health insurance policy. If you are planning for such treatments, then discuss with your insurer whether your policy will offer coverage for these treatments during the tenure period or not. Unless you are recommended by a doctor or it is a part of your treatment, your insurance company will not bear the costs of these treatments.
- Pre-existing Illnesses: Most insurance companies offer coverage for pre-existing illnesses after a certain period (the waiting period). This waiting period may vary from insurer to insurer. The range of the waiting period is from 12 months to 48 months. These days, many new health insurance plans are offering coverage for PED from day 1. Some insurance companies will cover pre-existing diseases by taking additional premiums from the customers.
- Infertility/Pregnancy-related Complications: Infertility treatments, including pregnancy complications (abortions), are not covered by health insurance plans. Though some maternity health insurance plans offer coverage for these treatments, most indemnity health insurance plans don’t offer coverage for these types of treatments. Check your policy wordings before making any commitment if you are looking for pregnancy-related expenses.
- Health Supplements: Health supplement pills or tonics are not covered by any health policy. If your treating doctor recommends these as your treatment part, then these expenses will be covered by the policy. But if you are consuming these supplements without any prescription, then your policy will not offer coverage against this. Check your policy wordings for more clarifications.
- Health issues due to consumption of drugs, alcohol, and smoking: Drug addicts, smokers, or regular alcohol drinkers are more susceptible to various lifestyle diseases than healthy people. Some severe ailments like stroke, mouth cancer, liver damage, bronchitis, etc., are the results of high consumption of drugs, smoking, or alcohol. Under these circumstances, most health insurance policies will reject your claims.
- Congenital Diseases/Genetic Disordered: Congenital diseases or genetic disorders are conditions that a person carries during the time of his/her birth. This is further divided into two categories, external congenital such as extra skin formation, etc., and internal congenital such as a weak heart. A health insurance policy won’t offer coverage for any of the diseases.
- Self-Inflicted Injury: A health insurance policy will not bear any expenses for injuries caused due to any self-attempted or suicide attempts. A health insurance policy plan even doesn’t cover any damages caused due to any self-injury. The list of diseases in India that are covered under a health plan prohibits the inclusion of diseases caused due to self-induced injuries.
- Transmitted Disease: Only a few health insurance policies in India offer coverage for transmitted diseases like HIV, Sexually Transmitted Diseases (STD), gonorrhea, etc., to some extent or for a limited period. Since you need prolonged treatment for these diseases, hence expenses are also high. That’s why health insurance companies won’t prefer to cover these diseases.
- Expenses for alternative treatment: These days, many people prefer alternative treatment methods like naturopathy, acupressure, acupuncture, reflexology, etc. to overcome their diseases. But these treatments are not included in health insurance coverage.
- Diagnostic tests: If you opt for some diagnostic or pathological tests like blood tests, urine tests, scans, imaging tests, etc. from a hospital or a diagnostic center, then these charges are excluded from your health insurance coverage. You will only get expenses for these tests if they are mentioned in your policy.
- Permanent exclusions: Permanent exclusions like injuries due to war, nuclear attack, riots, etc. are not covered by a health insurance plan.
The need for health insurance exclusion
Though exclusion is thinning the scope of the health insurance coverage, still it is imperative in health insurance.
The below-mentioned points will help you to understand the importance of exclusion.
- The risks that Indian insurance companies are not interested to reimburse for
- Certain risks are uninsurable as they influence many people at once – for example, war and natural calamities
- Certain healthcare expenses can be manageable by the policyholders, hence don’t need coverage
The Bottom Line
Though the list of inclusion may vary from insurer to insurer, the list of diseases that are not covered by health insurance (exclusion) will remain the same for all. Before purchasing a policy, a customer should be fully aware of all inclusion, exclusion, and other terms and conditions of the policy. In short, as a policyholder, you must be aware of the list of diseases covered in health insurance.