Key Exclusions to Consider in Your Health Insurance Policy

Why Should You Check Exclusions Before Buying Health Insurance?

Exclusions are those healthcare expenses and medical conditions that are not covered by your health insurance plan. As a result, your health insurance company is not liable to pay for excluded medical expenses. Raising a claim for a medical condition or expense that is excluded from your policy will lead to claim rejection.

Exclusions are not standard across all health insurance plans. This is why you must read your policy terms and conditions carefully before purchasing health insurance and clearly understand you’re your insurer will not pay for. This will save you from any nasty surprises that you may get at the time of claim settlement.

Common Exclusions of Health Insurance

Check out some of the most common exclusions of health insurance plans:

1. Pre-Existing Diseases

Pre-existing diseases or medical conditions you already suffer from while buying the policy are excluded under health insurance. These diseases are covered after a waiting period of 2-4 years, depending on the policy. However, some plans now cover pre-existing diseases from day 1 too.

2. Pregnancy and Related Conditions

Medical expenses incurred due to pregnancy and childbirth, such as delivery charges, newborn baby expenses, pre & post-natal expenses, abortion, baby vaccination costs, miscarriage, etc., are not covered under your policy. You can opt for the maternity benefit as a rider or an add-on cover to get your pregnancy costs covered.

3. Non-Medical Expenses

Non-medical expenses incurred during hospitalization, such as needles, syringes, cotton, bandages, gloves, sanitizers, masks, gowns, PPE kits, etc., are excluded under medical insurance. You can opt for a consumable add-on to get your non-medical expenses covered.

4. OPD Treatment

Most mediclaim insurance plans do not cover the cost of medical consultations taken at the outpatient department (OPD). You can opt for an OPD benefit rider or add-on to get your OPD expenses covered.

5. Cosmetic Surgery

The cost of cosmetic surgery or plastic surgery is not payable by insurance companies unless resulting from an accident.

6. External Congenital Diseases

Any medical expenses or treatments arising from external congenital diseases, such as Down syndrome, cleft lip, club foot, etc., are not covered under insurance plans.

7. Dental Treatment

Dental treatment costs is also not payable under health insurance unless necessitated due to an accident.

8. Self-Inflicted Injuries

Any medical expenses arising out of injuries made deliberately, such as suicide or an attempt to suicide, will not be covered by health plans.

9. War & Related Perils

Medical insurance also does not cover the medical expenses incurred to treat injuries or diseases resulting from war or related perils.

10. Waiting Period Clause

All health insurance plans in India come with a waiting period clause. As per this clause, all health plans come with an initial waiting period of 30 days and specific diseases waiting period of 1-2 years. During the waiting period, your insurance company will not honour your claims and reject them, except for accidental claims.

Over to You!

Every health insurance policy has its own exclusions. Choosing the one that covers your requirements is an art. Going over the policy exclusions before buying is the first step in that direction. Make sure to choose a policy that fulfils all your requirements with minimal exclusions.