While health insurance plans protect your family, they also come with exclusions you should be aware of. Such exclusions include medical conditions or specific circumstances where no compensation is provided or diseases covered only after a particular waiting period.
Says Rakesh Goyal, director of Probus Insurance Broker: "One of the most important aspects of buying health insurance plans is to look for exclusions. It's like looking at the company's balance sheet and profit and loss statement before buying their shares. Exclusions can include medical conditions, wherein insurers can reject the claims."
Not being aware of these exclusions often causes disappointment and distress during a medical emergency. Therefore it is always advisable to read your policy documents before buying a health insurance policy and understand the exclusions.
Here are the common exclusions in health insurance:
Pre-Existing Diseases: "A pre-existing disease is any illness a policyholder has faced before buying a health insurance policy. Every health insurance company has a waiting period depending upon the type of disease, which may range from two-four years or more. Generally, diseases such as cataract, arthritis, congenital diseases, cosmetic surgeries, etc., are excluded," says Naval Goel, founder, and CEO, of PolicyX.com.
Waiting Period: When you are in the waiting period, you cannot make any medical claim. A policyholder can avail of all the benefits of the policy only after the completion of the waiting period. Every insurance policy has rules for specific illnesses that are not covered until the waiting period is waived. To start availing of the plan's benefits, a policyholder must wait for a pre-defined waiting period.
Lifestyle Diseases: Lifestyle-oriented diseases include lung disease due to excessive smoking or liver and pancreas disorders due to drinking too much alcohol. Such ailments are entirely excluded or covered with high premiums under health insurance policies.
Cosmetic Procedures: Many people prefer cosmetic surgery to improve their facial features. However, it is excluded from health insurance except under specific situations like accidents or injuries.
Maternity Expenses: Maternity expenses are often not covered under standard health insurance policies. To get this covered, you may need to contact an insurer and enquire about the availability of a specific policy or add-on. However, pregnancy is covered in some health insurance plans but only after a certain waiting period. Some insurers do cover newborn babies after a waiting period of 90 days.
Mental Illness: Mental health issues, such as depression, anxiety, panic attacks, and schizophrenia, are excluded from health insurance policies. However, you could always check with your insurance provider to get a better understanding.
Sexually Transmitted Diseases: Health insurance excludes sexually transmitted diseases such as HIV and Aids.
Dental Treatment: Dental procedures are typically not covered under health insurance unless a need for dental treatment arises out of accidental injuries.
Ophthalmic OPD Treatment: Ophthalmic OPD treatments are covered only under some health insurance plans. Most of the time, these procedures do not need hospitalisation.
Deliberate Injuries: Whether self-inflicted injuries or any injuries arising out of attempted suicide are excluded from health insurance.
Permanent Exclusions: "Congenital diseases or damage due to war and nuclear weapons are permanently excluded from the health insurance policies," adds Goel.
"Nowadays, one should also keenly look at the hospital expense limit, which includes room rent and doctors' fees. Anyone who wants to buy health insurance should compare the exclusions among a few policies and later zero in on the best one," adds Goyal.
