Common Exclusions in Health Insurance
With health-related issues becoming more complex in nature, it is important to have a health insurance plan in place for you as well as your family. But it is important to know that your health insurance policy may not cover each and every medical expense. Every health policy comes with a list of exclusions which you have to be aware of beforehand.
What is Exclusion in Health Insurance?
Exclusion indicates a medical expense or a health condition that will not be covered by your health insurance i.e., the insurer simply won’t pay for those expenses.
So, you need to read the inclusions and exclusions as well as the Terms and Conditions of a health insurance policy before buying one.
Common Exclusions in Health insurance
- Cosmetic Treatments
Any procedure or surgery that you undergo to enhance your appearance is considered a cosmetic treatment and is not covered by health insurance.
However, any medically recommended procedures such as plastic surgery to treat an accident or injury will be covered.
- Injuries caused due to suicide attempt/self-harm
Any medical expense occurring due to treatment of injuries caused by a suicide attempt or self-harm is not covered by your health insurance.
- Permanent Exclusions
Treatment of AIDS, injuries caused due to war, congenital diseases, and intentional injuries are not covered by your health policy.
- Alternative therapies
Many health plans do not cover treatment costs taken under alternative therapies such as Ayurveda, Naturopathy, Unani, Siddha, etc. The primary reason for this is because alternative therapies are unregulated and difficult to determine the exact duration and cost of treatment.
However, nowadays, many insurers cover alternative treatments such as Ayurveda, Homeopathy, and Naturopathy with some conditions on the cost of treatment.
- Pre-existing medical conditions
For pre-existing medical conditions, any health policy will mention the waiting period post which the treatment costs will be covered. The waiting period will usually vary from 2-4 years. Your insurer will not pay for any medical expenses for treatment of the pre-existing diseases within the waiting period specified.
It is very important to declare all your pre-existing diseases when you buy a health insurance plan. Failing to declare may not only result in your claims getting rejected but also in the cancellation of your health policy due to incorrect information.
- Dental, Hearing, and Vision
Dental treatments, vision correction treatments such as cataracts, purchase of spectacles, purchase of hearing aids, etc., are not covered by health insurance as they do not require hospitalization.
However, if any treatments for dental, hearing or vision requires hospitalization, it will be covered.
Many health insurance companies offer riders to cover these expenses.
- Pregnancy and childbirth
Most health insurance policies do not cover expenses related to pregnancy and childbirth. Also, expenses related to infertility treatment and abortion are not covered.
However, riders can be bought separately to cover these expenses.
- Lifestyle-related diseases
Any diseases that are caused by your lifestyle are excluded from health cover.
For example, if you are a smoker any medical expenses to treat lung-related diseases are not covered. If you are a heavy drinker, then any medical expenses related to diseases like liver cirrhosis will not be covered by your health insurance.
- Diagnostic tests and consultation
The cost of any diagnostic tests such as scanning, X-ray, laboratory tests, doctor consultations, etc., that are routinely conducted are not covered by your health insurance. However, if the outcome of such tests or consultation results in hospitalization, then such expenses are covered as pre-hospitalization expenses.
You can also refer the IRDA circular on the common exclusions in health insurance.
Many health insurers offer riders to cover the cost of diagnostic tests and Outpatient consultations irrespective of whether it results in hospitalization or not.