Home Health What Are The Key Exclusions In A Health Insurance Plan?

What Are The Key Exclusions In A Health Insurance Plan?

by Rosy

In the last few decades, the lifestyle has changed drastically that increased the complexity of the health-related issues. Thus, it has become essential to have a health insurance plan intact. Health insurance provides financial support in case of medical emergencies. The insurance company helps in clearing dues accumulated as medical expenses and hospitalization.

If you do not take care while purchasing the health insurance plan, the future may hold some nasty surprises. We often do not read the forms carefully while buying a health insurance plan. Most people read about the inclusions but often miss out to see what all are excluded under the chosen plan. Though most of the Health Insurance Plans cover common illnesses, there are certain medical conditions, also known as critical illnesses that are excluded from a general health insurance plan.  

Know about the exclusions before making a decision

You have to be very mindful while reading the form and make sure that you know about the exclusions. It will help in filling out the claim forms properly when you need it. Exclusions vary from person to person and policy to policy. However, certain exclusions are common among most of the health insurance plans.

  • Pre-existing medical conditions: If the policyholder has any pre-existing health conditions, it is important to declare the same while purchasing the insurance. All pre-existing conditions will get coverage but only after a specific lock-in period that can be up to four years from the purchase date. However, if you fail to declare the illness, you will not get the benefits.
  • Alternative therapies: Many insurance companies do not provide cover for alternative therapies including Naturopath, Homeopathy, Unani, Magnetic therapy, acupressure and more. If you are taking any of these treatments, there is a possibility that the insurance policy will not cover the cost of treatment.
  • Lifestyle-related conditions: Some diseases are incurred because of your lifestyle, such as lung disease because of smoking or liver disease because of drinking. The only way to get cover for such lifestyle-related problems is by paying a higher premium amount, and that too is possible in limited insurance plans.
  • Cosmetic treatments: In today’s time, people are more inclined to use cosmetic treatments to improve their appearances. Such treatments are not covered under health insurance plans. However, if the cosmetic treatment such as plastic surgery is recommended to treat an or injury, it will be covered under the insurance plan. Dental treatments are also not covered under the health plan coverage. Insurance companies have a separate dental insurance plan that you can opt for.
  • Pregnancy and childbirth: Many health insurance plans do not cover pregnancy and childbirth-related expenses. Also, treating infertility and abortion are not covered by insurance companies.
  • Diagnostic expenses: Insurance companies often do not provide cover for the diagnosis. However, if the diagnosis gives a positive result for any illness or injury that will require hospitalization, the insurance plan will cover its cost.
  • Hearing and vision procedures: Most of the insurance plans do not provide cover for hearing or vision procedures unless they require hospitalization. You can buy add-ons to get them covered.
  • Injuries caused due to suicide attempt: If the policyholder attempts suicide or self-harm, any medical expenses incurred as a result will not be covered under the insurance policy.
  • Permanent exclusions: Certain exclusions are permanent such as HIV, injuries incurred in a war, congenital diseases and more. It is important to read the fine print before you buy the insurance plan.
  • Learn about the waiting period: Certain exclusions are for a limited period. For example, if you have a pre-existing disease, the insurance company will only cover it after a certain period. It depends on the nature of the exclusion and the plan that you have opted that for how long you have to wait to get the said cover.

Making the right choice is the key

There are certain conditions that every insurance company imposes on the policyholder to save company’s interests. The exclusions in a health insurance plan make sure that buy buyer and seller of the insurance policies are indulging in fair practices. Please note that there are many health conditions that general health insurance plans will not cover. Health problems like cancer, heart disease etc. are known as critical illnesses and you have to buy a separate critical illness cover for them.

It is up to the insurance company to clear the claim once you have applied for it. To reduce the chances of rejection, you must provide correct information about your health while filling up the form. Also, make sure to follow the process of filing the claim. If possible check for the policies that provide cashless cover. It helps in speeding up the claim process.