Knowledge Centre

4 Common Health Insurance Exclusions

Health insurance is a kind of insurance that offers us financial protection during a medical crisis, by paying for our hospital and other medical-related bills. While health insurance policies generally cover most common illnesses, there are certain kinds of medical conditions not included in the coverage. Also, some diseases are covered after a specific waiting period. At times your health insurer may not provide you a health insurance plan if you are already suffering from a critical ailment.

Investing in a health insurance policy that doesn’t support you in times of emergency is as good as not having an insurance policy at all. Very often customers do not read the fine print before investing in a health insurance policy. They are in for a nasty surprise when their medical bills (for exclusions) are not covered. This means they would have to bear these expenses from their pockets.

So, in order to spare yourself from any unpleasant surprises, it is necessary to go through all the inclusions, exclusions, and limitations of a policy before investing in one.

Although these exclusions vary from one policy to another, there are certain common exclusions in health insurance policies. A few of these are:

1. Pre-existing medical conditions

Commonly referred to as pre-existing conditions, any ailments that you already have while applying for insurance are not covered under your health insurance policy. This is because insurance covers the risk of an uncertain event and not something that is already prevails. Even if your health insurance provider agrees to cover a pre-existing condition, there will generally be a waiting period of about two to four years before the ailment is covered. A waiting period is the time span from when you buy your policy to when you start getting coverage from it.

2. Cosmetic treatments

One of the most common exclusions in health insurance policies is cosmetic treatments. However, costs of a plastic surgery following an accident or injury are covered under medical insurance. Besides, joint replacements as well as dental surgeries are some of the well-known health insurance policy exclusions.

3. Injuries caused due to suicide attempts

Injuries arising out of any act of self-harm or suicide attempts are not included in most health insurance plans. An insured will not be covered in case he harms himself intentionally.

4. Therapies

Health insurance plans do not cover therapies like naturopathy, acupressure, magnetic therapy, and other such alternative treatments.

Before investing in a policy, one has to also keep in mind its waiting period. The insurance market has different waiting periods in health insurance that span from:

  • Two to four years for pre-existing diseases

  • One to two years for conditions like hernia, osteoporosis, and Ear, Nose, Throat (ENT)-related disorders

You can also read more about inclusions of a health insurance plan.

The above information is for illustrative purpose only. For more details, please refer to policy wordings and prospectus before concluding the sales.

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