Common exclusions in a health insurance policy that you should know
Varun (28-years-old) lives in Pune with his Parents (Father: 57 years and mother: 50 years). Varun purchased a health insurance floater policy a year ago to safeguard his parents’ health as his father has cardiac problems. But Varun’s father got a heart attack last month, and he was admitted to a non-network hospital of the insurance company. After getting discharged from the hospital, Varun raised a claim for his father’s treatment to the insurance company. But the insurance company has rejected the claim because the waiting period for pre-existing disease (cardiac problem) is 2 years. So, Varun can’t initiate a claim within these two years for PEDs. Thus, people like Varun should know health insurance exclusions before purchasing a health policy from an insurer.
Before investing a single penny in health insurance, every customer should carefully go through the terms and conditions that are mentioned in the policy plan. Eminent insurance companies usually provide the list of diseases not covered under health insurance policy plans so that the customers don’t raise any claim for these conditions. Being a scrupulous person, every policy buyer should check all permanent exclusions in health insurance for a convenient claim process. To avoid untoward surprises in the future, you should pay extra care before committing any health insurance purchase.
Most health insurance companies usually cover all common diseases/ailments. But certain diseases are not covered under these policies. These conditions are known as exclusions in health insurance policies.
List of 10 diseases that are not covered under health insurance plans
Though many diseases are covered under mediclaim policies, insured policyholders don’t get any compensation from insurers for certain ailments. Here, we are going to mention a list of health insurance exclusions that every policyholder should be aware of while purchasing health insurance policies.
- Pre-Existing Diseases
- Abortion and Pregnancy Expenses
- Cosmetic Surgeries, including Dental Treatments
- Diagnostic Expenses
- Health Supplements
- Injuries caused because of suicidal attempts
- Vision and Hearing
- Diseases due to Alcohol Consumption
- Alternative Therapy
- Permanent Exclusions
Pre-Existing Diseases
Generally, pre-existing diseases (heart disease, kidney disease, diabetes, cancer, etc.) are omitted from the coverage of your purchased health insurance policy. You can initiate a claim for these diseases after the completion of the waiting period pronounced by your insurer. The waiting period is between 2-4 years for most insurance companies. The policyholders won’t receive any compensation or reimbursement for pre-existing ailments during this waiting period. To make your health investment-worthy, you should purchase a health insurance policy as early as possible so that your waiting period gets finished hurriedly for pre-existing conditions.
Abortion and Pregnancy Expenses
Most health insurance policies don’t compensate for the cost of childbirth, maternity, and pregnancy. These policies also don’t offer any coverage for infertility treatment and abortion costs. However, suppose you want maternity coverage or newborn coverage. In that case, you can opt for an add-on rider or purchase exclusive maternity insurance that will bear all expenditures of maternity and childbirth.
Cosmetic Surgeries, including Dental Treatments
Cosmetics surgeries are very common these days as people are spending a humongous amount on these treatments to improve their look, appearance, and self-esteem. But health insurance policies don’t offer coverage for any type of cosmetic treatment. So, if you are planning for a cosmetic treatment, you need to pay money from your pocket. But if a doctor recommends cosmetic surgeries because of an accident, insurers will bear the treatment expenses. Similarly, health insurance policies will not pay anything for dental treatment procedures.
Diagnostic Expenses
Sometimes, you need to perform laboratory tests or imaging to identify your disease or conditions. These tests are not budget-friendly and will make a hole in your pocket. Unfortunately, no insurer compensates for the cost of these tests. But if there is a hospitalization because of the test results, then some insurance companies will cover the hospitalization and treatment costs.
Health Supplements
Any health insurance policy plan does not cover all health supplements, including pills or protein shakes. But if these are parts of your treatment and recommended by a physician to improve your condition at the time of hospitalization, then insurers can bear the cost.
Injuries caused because of suicidal attempts
A health insurance policy doesn’t cover any kind of self-injury or suicide attempt. Therefore, if the policyholder tries to hurt himself/herself deliberately, then he/she won’t receive any reimbursement from the insurance company.
Vision and Hearing
To improve your vision and hearing problem, if you need to buy any product, then it won’t be covered by any health insurance policy. But if you get admitted because of vision or hearing loss, then your treatment will be covered by insurance companies.
Diseases due to Alcohol Consumption
Are you suffering from any liver problems because of uncontrolled consumption of alcohol or any other substance injuries? Then, you won’t get any compensation from a health insurance policy for your treatment. Insurance policies won’t offer coverage for liver damage due to unrestrained consumption of alcohol. Smokers or alcoholic people need to pay higher premiums because these people are more vulnerable to life-threatening diseases like cancer, stroke, lung diseases, etc.
Alternative Therapy
Some Indian insurers offer hospitalization coverage of ayurvedic and homeopathy treatment. But most insurance companies are unwilling to provide any coverage for alternative treatment methods like acupuncture, naturopathy, magnetic therapy, etc.
Permanent Exclusions
Certain conditions like War injuries, HIV, congenital diseases, etc., are permanently excluded from health insurance plans. So don’t forget to ask your insurer about health insurance exclusions before investing a single penny.
Diseases covered under Mediclaim
Some common diseases that are covered by most health insurance policies are,
- 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?
If you need expensive medications as part of your treatment and doctors prescribe them, then the insurer may reimburse the cost of medicines.
If you initiate a claim for the above-mentioned exclusions, your claim will be declined by insurance companies. To purchase a health insurance plan, go through the inclusions and exclusions entirely so that you don’t need to feel the pain of rejection.
