Health Insurance Exclusions: What Is Not Covered in Indian Health Insurance Policies!

Purchasing a health insurance policy is one of the most important financial decisions you will make in your life. It is going to be extremely fundamental to get health insurance as early as possible because it makes substantial changes in your financial planning. There are also things you must understand about these health insurance plans. One of those things is the coverage of the insurance plan.

When you compare health insurance policies and read the features and coverage of those plans, you will observe that there are some diseases or conditions that are included under the policy. There are some conditions that the policy cannot fund. Those are the exclusions in health insurance policies.

Let us discuss these exclusions in detail. This knowledge will help you make better decisions regarding how to get enough and appropriate coverage for yourself or your family.

Health Insurance Exclusions

Specific items, treatments, or conditions that your health insurance plan does not cover are the health insurance exclusions. There are various reasons behind these conditions being in the exclusion section of your policy.

These exclusions are mentioned in the policy documents, and understanding them will help you make educated decisions regarding healthcare and financial planning.

The list of exclusions mentioned in this blog is a generalisation and most found conditions in the majority of policies. You will have to read your policy to get a better idea for yourself.

List of Exclusions in Health Insurance

Sr. No. Disease/Condition Reason
1. Cosmetic Surgeries Health insurance plans do not usually include cosmetic or aesthetic treatments. Since these types of treatments or surgeries are not medically necessary or are not health issues, they are excluded from health insurance policies.
2. Pre-Existing Conditions Pre-existing conditions are exclusions in medical insurance for the waiting period because those are the conditions you already had when you bought the insurance. When there are high chances of raising a claim, insurance companies usually do not take the risk; hence, these conditions are stalled for over 1-2 years (the waiting period.)
3. Transmitted Diseases Sexually transmitted diseases are not included in insurance policy coverage unless and until they are a result of a non-consensual act.
4. Injuries from Self-Harm If the policyholder suffers from injuries as a result of self-hurt or suicidal tendencies, they are not considered in the insurance policy coverage. Self-harm and intentionally hurting oneself is a call for help and professional advice, though.
5. Addiction After-effects If there is a health condition that is a result of addiction to intoxicating substances like alcohol, cigarettes, or drugs, they are not included in the health insurance policy. These habits can lead to heart stroke, lung diseases, kidney and liver issues, etc. Hence, these lifestyle-related health conditions are exclusions in medical insurance.
6. Alternate or Non-Proven Treatments There are many alternative medical treatments like homoeopathy, ayurveda, reiki, or unani. These are not Western medicines or scientifically proven medicines and, hence, are not covered under most of the health insurance policies. Some policies might have limited coverage for these types of treatments.
7. Dental-Vision-Hearing Any issues or conditions related to your vision, teeth, or hearing abilities are not considered in insurance policies unless the issues result from an accident. Routine checkups or vision and hearing enhancement treatments are not covered under the standard health insurance policies.
8. Abortion Most insurance policies cover abortion when recommended (or, in medical terms, medically necessary termination of pregnancy) but not a voluntary one. Because it is a policyholder’s choice and not a health-related decision, it is excluded from the insurance policy.
9. Pregnancy Complications/ IVF / Infertility Treatments Treatments related to pregnancy complications or infertility treatments are not considered in the insurance coverage because, again, they are not health conditions or medical issues. These are voluntary decisions of the policyholder that are not necessarily prescribed by a doctor.
10. Injuries from Hazardous Activities Injuries that are a result of hazardous activities, like dangerous sports or adventure, are not covered in a health insurance policy.

Conclusion

Making the right decision is essential, and for that, having the right information is necessary. You must understand these features: policy inclusions, policy exclusions, policy premiums (by using the online health insurance calculator), add-ons, riders, maturity benefits, No Claim Bonus, etc.

These features make a policy beneficial for you. To make the most out of health insurance, understand it thoroughly.

That is why understanding health insurance exclusions is also important, too!