It is mandatory for health insurance companies to provide a list of exclusions from their plans that comply with the guidelines issued by IRDAI. Nevertheless, an insurer may reject claims arising from hospitalization related to the specific list of illnesses not covered by health insurance.
With the rising medical costs, increasing number of illnesses and high inflation rate, having a health insurance policy has become mandatory. Adequate health insurance can ease the financial burden during a medical emergency, should one arise. However, when selecting a health insurance plan, you must ensure that the policy covers your specific needs.
Insurance advisors suggest opting for a policy that best suits their needs and offers emergency medical support in the event of hospitalization and/or treatment.
Often, health insurance buyers don’t read the fine print before investing in a policy. They then end up having to bear the expenses of various medical requirements which are not covered by the policy. Therefore, it is necessary to check all the inclusions, exclusions and limitations of a policy before buying it.
Read also :
However, it is mandatory for health insurance companies to provide a list of exclusions from their plans which conform to the guidelines issued by the Insurance Regulatory and Development Authority of India (IRDAI). Nevertheless, an insurer may reject claims arising from hospitalization related to the specific list of illnesses not covered by health insurance.
Let’s look at some common exclusions in health insurance policies.
Pre-existing medical conditions
If a person suffers from an illness when applying for insurance, they are not covered by the health insurance policy. Indeed, health insurance covers the risk of uncertain events and not those that already exist. However, pre-existing conditions are covered after a waiting period of two to four years or more, depending on the type of condition and its risk.
Health insurance policies do not cover cosmetic surgeries because they are not life-saving medical procedures and are not considered life-threatening. Therefore, liposuction, botox, or surgeries of a similar nature are not covered by health insurance policies. However, plastic surgery costs following an accident or injury are covered in some policies.
Pregnancy and childbirth
A health insurance policy does not cover medical expenses during pregnancy, childbirth or abortion. A few health insurance policies, called maternity insurance plans, provide coverage, but with limitations. Policies have a waiting period of one to two years. Thus, expenses related to pregnancy or childbirth during the waiting period will not be covered by the policy. In addition, maternity insurance does not cover medical costs for the birth of a third child.
Health insurance plans do not cover dental conditions because they do not require hospitalization. However, dental care costs are covered in the event of accidental injury.
Injuries from suicide attempts
If an injury occurs as a result of an act of self-harm or attempted suicide, a health insurance policy will not cover it.
A health insurance policy does not cover costs incurred for pathological monitoring such as blood tests and CT scans. Additionally, there are standard sets of exclusions that are not covered by health policies, such as the cost of contact lenses, glasses, and hearing aids.
Exclusions vary from policy to policy. Therefore, it is important for individuals to check the coverage available for basic treatments and seek additional coverage based on their needs. A person can opt for additional coverage with an additional premium to ensure that your application is not rejected.