Common Exclusions in Health Insurance Policies - Greyfont

Common Health Insurance Exclusions

There has been a sudden rise in the health care issues in India due to the changing lifestyle of people. Also, since the medical costs are rising with each passing day, getting a health insurance plan, thus becomes important. Policyholders are often disappointed when their health insurance claim is rejected. This happens mainly because they fail to read through the list of exclusions of health insurance policy. Read below the list of exclusions under health insurance.


1. Pre-existing diseases:

If you are already suffering from a pre-existing disease, then the insurance company would not provide you coverage for the same for the next 3-4 years. There is a waiting period for the coverage of pre-existing disease and any ailment that is a result of such disease is not provided coverage for. Pre-existing diseases such as diabetes, cataract, kidney stones, etc. are excluded.


2. Alternative therapy:

If you resort to other medical treatments such as unani, ayurvedic, homeopathic and others, then no coverage is provided for the use of such therapies. Health coverage is only given for availing allopathic treatments. Naturopathy, magnetic theory, acupressure and other such treatments are also excluded.


3. Lifestyle related conditions:

Few insurance companies do not provide coverage for health conditions that are caused due to excessive smoking and drinking habits.


4. Cosmetic treatments:

If you plan to change your look and opt to do a cosmetic surgery to enhance your appearance, then the cost of this treatment is not covered by the insurance company. However, if you are required to undergo a cosmetic surgery that is a result of an accident or a disease, then the coverage for the same is provided. Similarly, dental treatments are also excluded from the coverage.


5. Pregnancy:

Costs for pregnancy, childbirth, etc. is not covered under a health insurance policy. However, few insurance companies do provide maternity cover but with a waiting period of 3-7 years.


6. Diagnostic expenses:

Routine diagnostic tests such as blood test, stool test, vitamin test, etc. can be expensive, but they are covered under a health insurance plan. If the tests are positive and require hospitalization, only then the coverage is provided.


7. Waiting period:

Few insurance companies have a standard list of excluded diseases, the coverage for which is provided after a waiting period of few months or years. For instance, treatment of internal tumours, cysts, tonsils, etc. is covered after a waiting period of 2 years. 


8. Injuries caused due to suicide attempt:

If the injury is a result of a deliberate act, then you are not eligible to receive any coverage for the same.


9. Dental and vision:

Both dental and vision treatments are not covered under health insurance. But if the requirement is due to an accident or a medical condition, then the same is covered.


10. Permanent exclusions:

Health insurance policies come with a permanent list of exclusions including HIV, injuries caused due to war, congenital diseases, etc. are not covered. 


Thus, it is important for you to be aware of the below list of exclusions before you purchase a health insurance plan. Besides this, every insurance company has its own list of inclusions and exclusions that you need to go through before zeroing down on a policy that secures your health.


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