Knowledge Centre

Medical Conditions Generally Not Covered Under Health Insurance

You must have come across many cases of health insurance policy holders who are looking to get coverage for mental illness as they are not informed about the fact that this coverage was a part of exclusions, hence claims denial or reduced payout terms was a normal scenario. Your medical insurance policy covers unforeseen medical emergencies, but there are some limitations as to what it can cover and what it has to exclude. And it’s always wise to know beforehand about the medical conditions which are generally not covered in your policy.

To ensure uniformity, the Insurance Regulatory and Development Authority of India (IRDAI) has standardized exclusions in a health insurance policy.

The following is a list of some medical conditions not covered under health insurance:

  • Pre-Existing Diseases: These diseases include ones which you may have had before taking the policy such as high blood pressure, diabetes, etc. Such medical conditions are not covered after you take a health insurance policy and any complications arising due to these conditions are also not covered under your health policy. However, there are some companies which do cover pre-existing diseases only after the individual has continuously renewed his policy without any breaks.

  • Cosmetic Surgery: Generally, health insurance policies do not cover cosmetic surgeries as it does not affect the well-being of an individual and is not life-threatening. Surgeries like Botox, liposuction and such others are not included in most health insurance covers.

  • Abortion: Abortion is still not legally approved and hence is excluded from health insurance policies.

  • Diagnostic Charges: The charges incurred to diagnose or identify the presence of diseases performed at a hospital or a clinic is usually not covered under health insurance policies.

  • Pregnancy: Treatment for pregnancy or any other emergency arising such as emergency C-section is not covered.

  • Alternative Therapy Charges: Costs incurred for alternative therapies like aromatherapy, acupressure, naturopathy, massage, reflexology, acupuncture and such others are not covered.

  • Supplements: Cost of supplements taken externally and not as part of a treatment are not included in the insurance policy. However, supplements and health tonics which are given by the physician as part of the healing process or treatment when a person is hospitalized are included in medical insurance.

  • Extra Charges: Extra charges such as registration fees, service charge or admission fees are not included in the health insurance policies.

  • Other Medical Conditions: Some specific medical conditions such as cataract, hernia, calculus diseases, gall bladder removal, hydrocele, sinusitis, joint replacement, piles, fistula in anus, benign prostatic hypertrophy and other age-related diseases such as osteoporosis, etc. are not included generally in medical insurance covers. However, some companies do offer variations on these diseases by offering time limits or partial cost covers.

How HDFC ERGO covered Mental Illnesses Seamlessly?

With HDFC ERGO’s my:health Silver Smart Health Suraksha plan any hospitalization caused due to mental illnesses will also remain covered seamlessly.

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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