Exclusions in health insurance

Unfortunately, health insurance does not provide coverage for all types of medical expenses. The diseases and other medical expenses that are not covered in health insurance are called exclusions. In simple terms, you are not given the facility of treatment if your insurance company has put those conditions on the exclusion list of your policy. Let us take an example to understand what an exclusion is.

Let’s assume that you are insured and your insurance company has put diabetes on the exclusion list. This means that if you develop diabetes in the future, the company will not provide coverage on medical expenses related to this condition.

If you are thinking of buying a health insurance plan, then go through its exclusion list so that you can be sure which diseases it does not cover.

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While buying a health insurance plan, people often try to find out only about the things that are being covered under the policy i.e. the inclusions. But it is important to know more about the exclusions than the inclusions so that you do not face any problems later.

It is best to do some research about the common exclusions before deciding which health insurance plan to buy. Always take a health insurance plan for yourself, which has more coverage and fewer exclusions.

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Every company has its own specifications so it may be possible that a disease is being covered by one company, while another company has included it in their exclusion list. However, there are certain medical expenses that are not covered by most health insurance plans. Some such exclusions are mentioned below:

• Pre-existing diseases: If you are thinking of buying an insurance plan and already suffer from a disease, then it is called a pre-existing health condition. These health problems are often not covered by insurance providers as health insurance is designed to cover uncertain health events and may not cover problems that already exist. However, at your request, the health insurance company can provide coverage for a pre-existing disease, but there is usually a waiting period of about two to four years for it. The waiting period is the period of time that is enforced by the health insurance company immediately after the insured buys the insurance. The insured can make a claim only after this period is over. Simply put, if you have a pre-existing disease and you request to cover it in a health insurance plan, then you have to complete the waiting period before you can claim for that disease. Along with this, the company may demand an additional premium for this.
• Cosmetic treatment: Beauty-related treatment and related expenses are also not included in the health insurance plan. If you are getting a treatment or surgery for aesthetic purposes, then you have to pay the cost of such treatments from your own pocket. However, if one has to undergo plastic surgery or any other cosmetic treatment as the result of an accident, then he is covered under the health insurance plan. On the contrary, if you are doing any cosmetic surgery, therapy or any other treatment of your own free will, then you have to pay the expenses incurred from your own pocket.
• Damage caused by self-injury or attempted suicide: If a person tries to commit suicide or attempts to cause any other harm to themself, then coverage is not given by the insurance company.
• Therapy: Certain therapies are also not covered in the health insurance plan, including neuropathy, acupressure, magnetic therapy and some other such therapies. If you are insured and get any of these therapies done, then you have to pay the cost of it out of your own pocket. However, every company offers many different types of health insurance plans and such therapies may be covered under some of them. In this case, the premium would reflect the coverage provided and may increase.
• Diseases related to teeth, ears and eyes: Some types of treatments related to your teeth, ears and eyes are not covered in health insurance plans. However, just like cosmetic treatments, if any dental, ear or eye-related treatment is required due to an accident, the insurance company does provide coverage for the same. If you want to include these medical expenses in your health insurance plan, then you can contact your insurer about this. (Read more: Dental treatment in health insurance)
• Pregnancy and childbirth: Medical expenses like pregnancy and childbirth are not covered in a regular health insurance plan. This means medical expenses for infertility treatment, checkups during pregnancy and childbirth would not be covered by the insurer. Apart from this, situations like miscarriage are also not covered. These conditions can be covered separately or can be included in your existing plan as add-on benefits.

(Read more: Maternity Health Insurance)

The need for exclusions in a health insurance policy is to protect the insurance company from going into losses. Certain conditions and situations indicate the need for exclusion in a health insurance plan, including:

• Expenses that can cause damage to the insurer company are usually removed for the policy.
• Some situations like natural calamities in which multiple insureds are affected simultaneously and insurers may be put under pressure cannot be included in the policy.
• Some health problems are on the exclusion list because the cost involved to treat them is not very high and can be paid by the insured out of pocket without the help of health insurance.

Considering all these situations, it is concluded that before buying any health insurance plan, one should know everything about it, including the exclusion list, so that you don’t have to suffer the consequences later.

If you are thinking of buying a health insurance policy for yourself or your family, then myUpchar Bima Plus can be a good option for you. In it, you will get more coverage and less exclusion along with 24x7 free tele-OPD facility. Other benefits and features are offered.

(Read more: Benefits of myUpchar Bima Plus for Elderly)