Exclusion in health insurance

Exclusions in Health Insurance

“Health” is our most valuable asset. It often defines our happiness and sense of fulfillment. No matter how health-conscious we are, our modern-day, evolving lifestyles may sometimes lead to unexpected and complex health challenges.

You are not alone! More than 13 crore Indians are likely to suffer from at least one of many lifestyle diseases, be it diabetes, cardiac ailments or various types of cancer in the coming years.

Preventive measures certainly help; yet, rising healthcare costs in India point towards the need for securing yourself and your family members with the help of an appropriate health insurance cover.

Health insurance ensures you are adequately prepared for health emergencies; you get sufficient financial protection for your medical expenses and hospitalization charges. It also makes sure you don’t have to utilize your savings and can better spend your money on other necessities such as food, education or retirement planning. The sheer relevance and utility of a Health insurance policy cannot be denied.

Are you Smart and Objective While Buying Health Insurance?


Most of us pay enough attention to what’s included in our health insurance policy, but do we pay sufficient attention to what’s not included, or in simple terms, what’s missing?

Decoding a health insurance policy document can be tough, given the complex list of terms and conditions. Many tend to give the in-depth study of the clauses a miss, only to regret later. Despite an increase in awareness about sub-limits, preexisting diseases, and other exclusions, claim denial or reduced payouts continue to shock.” Economic Times (ET)

Why Regret? Know the Exclusions

“Exclusions” can be described as medical conditions or expenditures that are not covered by your health insurance plan, and it means your health insurance provider will not pay for them.

Health insurance policies in India cover most illnesses; however, to avoid any surprises or disappointments in the future, one must go through the policy details and check all the exclusions.

Health Insurance Exclusions

1] Pre-existing Medical Conditions or Diseases:

  • The ones you are suffering from before buying health insurance.
  • Some examples: Cataract, Arthritis, Kidney stones, few Chronic diseases, and Joints treatment.
  • These are not covered, and you may have to wait for 2-4 years of the lock-in period, depending on the type of disease and its risk, before they are covered under your policy.
  • All existing health issues must be declared at the time of purchasing medical insurance.

2] Pregnancy & Childbirth:

  • Pregnancy, Childbirth, Vaccination, Abortion, Infertility treatment, and other treatment expenditures arising from or related to pregnancy, are not covered.
  • Some health insurance plans cover pregnancy but only after a waiting period of 1-2 years.
  • You may get some benefits if you plan a child after this waiting period.

3] Alternative Treatment & Therapies:

  • Such therapies and treatments are not covered under your health insurance.
  • Some examples: Ayurveda, Homoeopathy, Naturopathy, Unani, Magnetic therapy, Naturopathy, Acupressure.
  • Reason: Many such treatments are unregulated, have different costs, and it is difficult to determine their precise coverage.

4] Cosmetic Treatments & Surgeries:

  • All cosmetic treatments, procedures, surgeries such as Joint replacement and Dental treatments, are usually not covered under your health insurance policy.
  • Medically recommended procedures like Plastic surgery, in case of an accident or injury, are covered.

5] Hospital Costs & Diagnostic Expenses:

  • Costs such as sub-limits on room rent, Imaging, doctor fees, laboratory tests, and ambulance expenses are not covered.
  • Your insurer may cover the costs for any tests that yielded positive results for any illness leading to hospitalization.
  • One must check all the limits and exclusions mentioned in the policy document to be fully prepared for an emergency.

6] Lifestyle Diseases & Conditions:

  • These are not included in most health insurance plans unless you have paid a higher premium amount.
  • Some examples: Lung diseases caused due to smoking and Cirrhosis because of alcohol consumption.

7] Self-harm/Suicide Attempt:

If a person harms himself/herself deliberately or tries to commit suicide, any resulting expenses are not included in your health insurance.

8] Hearing & Vision Treatments:

  • Your health insurance does not cover hearing and vision procedures as they do not require any hospitalization.
  • The coverage is provided in case the hospitalization is required.
  • Some benefits can be purchased as additional features in your health insurance plan.

9] Permanent Exclusions:

Some examples: HIV, Injuries due to war, Intentional injuries, Congenital
diseases.

10 ] No Immediate Coverage/Waiting Clause:

  • Most policies, barring accidents and deaths, do not provide coverage immediately, even for diseases that are already included.
  • There could be a waiting period of 1-2 months before you get the benefits of a health insurance policy.

All policies, plans, and policyholders are not the same. Each plan brings a different set of features, and all of us may have a unique set of requirements. Therefore, as responsible, well-informed individuals; before buying any policy, we must carefully go through all the aspects, terms, conditions and exclusions, to avoid undesirable situations.

At Quickinsure, you can conveniently compare all healthcare insurance plans and policies by going through quotes from recognized health insurance providers.

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