5 Things Health Insurance Policies Usually Don’t Cover


Adequate health insurance helps ease the financial burden that comes with a medical emergency. There are many health insurance plans offered by different insurance companies. However, choosing the right one for yourself could be a difficult task.

Pankaj Arora, MD and CEO, Raheja QBE General Insurance, says, “One should opt for the policy that best suits one’s needs and provides support in difficult times, such as hospitalization due to injury or illness, etc. .

Here are some common exclusions listed as a reference for people looking to purchase health insurance;

Pre-existing disease

According to industry experts, this point is true for people who suffered from illness before purchasing health insurance.

Arora explains: “If someone has an illness before taking out the policy, it is not covered on the first day of the policy’s coverage.” These are known as pre-existing conditions and are usually only covered after a waiting period of 2-4 years or more depending on the type of condition and its risk.

Pregnancy and childbirth

Conditions related to childbirth are not included in a general health insurance policy. This includes pregnancy and conditions arising therefrom, abortion and any treatment arising out of or as a result of pregnancy.

“Few health insurance policies offer coverage (with a sub-limit) for pregnancy and childbirth after a 2-4 year waiting period,” says Arora.

Plastic surgery

Cosmetic surgery is generally used to improve a person’s appearance and is not a life or health threatening activity. Cosmetic surgery is a personal decision and is elective in nature. It is not a necessity; therefore, all kinds of cosmetic procedures are not covered by health insurance.

Arora points out, “Plastic surgeries are not life-saving medical procedures undertaken to protect the life of an individual and this is another reason why they are not covered by any health insurance. That said, in the event of an accident or injury when plastic surgery is necessary, it is usually covered.

Dental coverage

Dental conditions usually do not require hospitalization and are not covered by health insurance plans. That said, dental costs are only covered when required due to accidental injury.

Hearing and sight

With hearing and vision, Arora explains, “there could be two types of cases here, either it’s a pre-existing condition or it’s the result of accidental damage that requires hospitalization. Again, treatments that do not require hospitalization are not covered by a health insurance policy.

Not all health insurance plans are alike and therefore you should check the coverage available for basic treatments and look for additional coverage depending on your needs. “Additional coverage can always be chosen by an individual, which usually comes with an additional premium for health insurance,” adds Arora.


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