Health insurance is a valuable investment that helps cover your medical expenses. From hospital bills and pre-and post-hospitalisation expenses to daycare procedures and home healthcare, a health insurance policy covers them all. However, your health plan may not include certain conditions and services. These are known as health insurance exclusions. Therefore, when purchasing a healthcare plan online or through a health insurance app, it is essential to review the exclusions carefully. Doing so will help you make an informed purchase decision and prevent surprises later. Here, we will tell you about the common exclusions you may find in health insurance policies.
Common exclusions of health insurance
Health insurance provides comprehensive coverage to policyholders, helping reduce the financial burden during medical emergencies. However, it is essential to understand that health plans have exclusions, i.e., they do not cover certain conditions and hospitalisations. These exclusions may either be temporary (time-bound) or permanent. Let’s take a look at some common exclusions in health insurance policies.
Time-bound exclusions
Time-bound exclusions refer to the conditions or treatments not covered for a specific duration after policy commencement. The following are some common time-bound exclusions in health insurance —
- Pre-existing conditions: A pre-existing condition is a medical condition you get diagnosed with before purchasing health insurance. Common examples include heart disease, diabetes, high blood pressure, thyroid, and cancer. Health insurance policies typically cover pre-existing conditions after a waiting period of 1 to 3 years. However, some specialised plans may offer coverage for pre-existing conditions from day one, though they usually come with higher premiums.
- Specified diseases: Certain specified diseases, such as heart disease, cancer, Parkinson’s disease, multiple sclerosis, and stroke, are covered after a waiting period of 1 to 3 years from the policy commencement date.
- Pregnancy-related expenses: Health insurance policies do not cover pregnancy-related expenses unless you take a maternity add-on or rider. Moreover, these add-ons come with a waiting period of 9 months to 4 years or more. Therefore, if you are planning to conceive soon, you must select a rider with a shorter waiting period to ensure coverage when needed.
- Initial waiting period: All health insurance policies have an initial waiting period of up to 30 days, during which most claims are not covered. Therefore, if you get hospitalised during this waiting period, the insurer will not cover the expenses. However, hospitalisation due to accidents is covered from day one.
Permanent exclusions
Permanent exclusions refer to ailments and procedures excluded from coverage under the policy. However, some of these procedures may be covered if you take health insurance add-ons or riders.
- Cosmetic surgery: Health insurance policies generally do not cover cosmetic surgeries or procedures aimed at enhancing appearance. However, the insurer will cover the related expenses if the policyholder meets with an accident and requires reconstructive or plastic surgery.
- Dental, vision, and hearing procedures: Most health insurance policies do not cover these medical procedures. If you have an OPD or outpatient department add-on, the insurer may cover specific treatments and procedures. However, treatments resulting from accidental injuries may be covered under health insurance. Similarly, insurance providers may cover procedures that require hospitalisation, such as cataract surgeries.
- OPD treatment: Health insurance does not cover OPD or outpatient department expenses, which include doctor’s consultations, diagnostic tests, and minor treatments that don’t require hospitalisation. However, you can add the OPD rider to your policy to cover the bills. This rider is especially beneficial for the elderly or individuals with chronic conditions, as they may require frequent doctor visits and medications.
- Non-medical expenses: Health insurance policies do not cover non-medical expenses, such as the cost of syringes, needles, cotton, bandages, masks, gloves, sanitisers, and similar items. However, these costs can be covered if you opt for a consumables add-on cover.
- Self-inflicted injuries: Medical expenses arising from self-inflicted injuries are not covered by health insurance. For example, injuries resulting from self-harm or attempted suicide are excluded from coverage.
- Other exclusions: Health insurance policies typically do not cover congenital diseases, damages caused by war or nuclear activities, and infertility treatments. These are permanently excluded from most health plans.
Conclusion
To sum up, all health insurance policies come with a set of exclusions. Therefore, when purchasing a policy, make sure you go through the exclusions minutely. Some exclusions are time-bound or temporary; others can be covered with add-ons. However, there are also permanent exclusions that will not be covered under any circumstance. If you notice coverage gaps, you can choose relevant add-ons to enhance your health plan and better protect your health and finances. With the option to compare and purchase policies online or through health insurance apps, you can quickly find the right coverage for yourself and your loved ones.
