Health insurance policies contain lots of terms and conditions and unless you go through them with a fine-tooth comb, you will miss the exclusions. If you are not aware of them, you might face claim denials or reduced payout of the sum insured.
What are the most common health insurance exclusions?
If you are already suffering from an illness when you purchase a health insurance policy, your insurer will consider it a pre-existing illness. Most insurers do not cover pre-existing illnesses. And even if they do, you need to wait out a period of 2-4 years before you can receive the benefits of the policy. The exact waiting period depends on the type of illness.
Some illnesses like kidney stones, arthritis, cataract, joint disorders are not considered as pre-existing illnesses.
There are some policies that exclude maternity benefits like pre and postnatal care, health check-ups during pregnancy, the cost of delivering the child etc. And even when maternity benefits are included, they only kick in after 1-2 years from the date of purchase.
Certain surgeries like a knee replacement, facial rejuvenation, and dental procedures are excluded in all health insurance policies.
Alternative modes of treatment
Alternative treatment methods like homoeopathy, Unani, Ayurveda are usually excluded from a health insurance policy. Some policies do cover them but only at government-sponsored hospitals.
Treatment at your home
If you opt for continuing your treatment at home, your insurance policy will not cover it.
Even if a particular illness is not excluded, not all medicines needed for treating that illness may be included in your health insurance policy’s coverage. For example, chemotherapy drugs administered intravenously may be included but if they are to be administered orally, they may be excluded.
A health insurance policy will not cover the treatment of illnesses or injuries sustained during a suicide attempt.
Illnesses born out of substance abuse
If you fall gravely ill from chain-smoking, alcoholism or drugs, your health insurance policy will not come to your aid.
Fees of the resident doctor
If your resident doctor’s bill is not included with your room rent, your health insurance policy will not pay for it. Some hospitals do segregate the two and that might leave you in a tight spot. That is why it is advisable to seek treatment from network hospitals whose payment policies are aligned with that of your insurance provider.
Some other exclusions of a health insurance policy
- Screening cost for donors
- Treatment for psychological disorders
- Hearing aids or contact lenses
- Charges for bedpans, laundry or walking sticks
- Baby food
Health insurance policies can be your best friend at a time of medical emergency but they are only as good as the exclusions they come with. That is why you need to look into the exclusions before you decide which policy you will purchase.