Common Exclusions of Health Insurance

Most people buy health insurance with the expectation that their policy will cover every medical expense. In reality, all health insurance plans come with certain exclusions that are not payable by the insurance company. Read on to learn about the common exclusions of health insurance plans.

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      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.

      People also read: Pre-Existing Disease (PED) Cover from Day 1

      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.

      People also read: List of Different Types of Non-Medical Expenses in Health Insurance

      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.

      People also read: Does Health Insurance Cover Congenital Diseases in India?

      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.

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      *All the health insurance plans cover hospitalization expenses including COVID-19 treatment cover up to the specified limits. You can also buy specific COVID-19 health insurance policies such as Corona Kavach Policy and Corona Rakshak policy.

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      *₹1748/month is the starting price for a 1 crore health insurance for an 18-year-old male, with no pre-existing diseases. Discount on renewal premium is subject to the number of wellness points earned in the health insurance policy. For more details about the plans, please read the sale brochure carefully to get upto 100% discount on renewal premium.

      *₹400/month is the starting price for ₹ 5 lakh Health insurance for a 30 year old male & 29 years old female, living in Delhi with no pre-existing diseases

      *₹541/month is the starting price for ₹ 10 lakh Health insurance for a 30 year old male & 29 years old female, living in Delhi with no pre-existing diseases

      *₹762/month is the starting price for ₹ 1 Crore Health insurance for a 30 year old male & 29 years old female, living in Delhi with no pre-existing diseases

      *₹243/month(₹ 8/day) is the starting price for a 5 lakh health insurance for a 20-year-old male, non-smoker, living in Bengaluru with no pre-existing diseases

      *₹2020/month is the starting price for ₹ 1 Cr Health insurance for a 50 year old male & 50 years old female, living in Bangalore with no pre-existing diseases rounded off to nearest 10.

      *₹390/month (₹13 per day) is starting price for 1 cr. Health insurance for 25 years old male, with pre-existing diseases, residing from tier 1 city rounded off to the nearest 10.

      *No medical tests are required unless requested by the insurer’s underwriter. In-case of pre-existing diseases relevant medical proof would be required as per the terms and condition of the policy opted.

      *The values taken for effective cost calculation are indicative values and may change as per the selected plan.

      *Coverage upto double the amount of Sum Insured is available on certain covers for a minimum plan of Rs. 5 Lakh on the first claim only to an individual of upto 45 years of age with no pre-existing diseases. The benefit is available with or without extra cost depending on the plan chosen.

      *Coverage of pre-existing diseases is provided by insurer as per their underwriting policy.

      *The scope of coverage may vary from plan to plan.

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