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10 Most Important Health Insurance Exclusions

Team AckoJan 17, 2024

It is said that health is wealth. When you are healthy, you can go ahead and even conquer the world! To maintain your health in today’s time, you need a strong financial backup. This can be provided by health insurance. Health insurance in India will take care of your financial needs in case of a medical emergency. You can breathe a sigh of relief when you have adequate health insurance coverage.

Technically, a health insurance policy is a contract that specifies the terms and conditions of the insurance company along with what is covered under the policy. This document also enlists the situations that will not be covered under the policy. This means the policyholder cannot raise a claim for a situation that is listed under exclusions. In this article, we will take a look at 10 such conditions that you need to be aware of.




10 Most Important Health Insurance Exclusions

Such procedures require a good amount of money these days. However, maternity benefit may not be covered under a normal health policy. To get this coverage, you may need to get in touch with an insurer and inquire about the availability of a specific policy or an Add-on.

#2 Cosmetic surgery

A cosmetic procedure done to enhance certain body parts is mostly not covered under medical insurance. Thus, if you wish to undergo any such procedure you may have to arrange the required funds by yourself. It is important to note that many insurance companies might cover cosmetic surgeries in case of a major accident causing disfigurement.

#3 Teeth, Ears, and Eyes

Any medical procedures related to dental issues, hearing, or vision may not be covered under medical insurance. This is simply because such surgeries do not require inpatient hospitalization.

#4 Pre-Existing Diseases

Most of the health insurance companies do not cover pre-existing diseases. If they do, there may be a waiting period applicable for availing the coverage. It is important to check the coverage while buying the medical insurance policy.

#5 Therapies and Alternative Treatments

After an accident, a person may have to undergo follow-up treatments such as physiotherapy. Some people may undergo alternative treatments like Ayurveda, etc. These procedures may not be covered by your insurer as only allopathic treatments may be included.

#6 Self Inflicted injuries

Suicide attempts i.e. intentional harm to oneself is not covered by many health insurance companies.

#7 Joint replacement

One of the most common surgeries people undergo is joint replacement surgery. The need may arise due to factors like old age or some diseases. However, the expense arising from these surgeries may not be covered by your insurer.

#8 Waiting Clause

As mentioned earlier, some conditions have a waiting clause applicable to them, these could be maternity benefits or pre-existing diseases. A waiting period may range from 2 to 4 years depending upon the insurer. You need to read the policy document to understand this clause specified by your health insurance company.

#9 Specific Expenses

Your health insurance in India may list some limits on expenses that will be borne by your insurer. These could include a sub-limit on room rent or doctors’ fees. Ancillary services like ambulance, lab tests, etc. may also not be covered.

#10 Permanent exclusions

Some situations are permanently excluded from your health insurance policy. These are: HIV, war, nuclear activities, congenital diseases etc.

The Bottom Line

Health insurance provides a financial backup in case of an emergency. However, it is important to understand that an insurer may have certain limitations on the policy. It is always a good idea to familiarize yourself with exclusions before purchasing the health policy.

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Disclaimer: *Except for exclusions like maternity benefits, undisclosed diseases, etc. Please check policy wordings for more details.
**The content on this page is generic and shared only for informational and explanatory purposes. It is based on industry experience and several secondary sources on the internet; and is subject to changes. Please go through the applicable policy wordings for updated ACKO-centric content and before making any insurance-related decisions.

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