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Common Exclusions in Health Insurance Plans

Published On Dec 22, 2020, Updated On Feb 12, 2021

Insurance exclusions are the conditions that are not included in the insurance contract, and in those cases, the insurance company does not provide coverage for them. All insurance policies have some exclusions, which indicates that they do not cover the insured for definite aspects, during a medical crisis as well.

It is essential for policyholders to be aware of the health insurance exclusions to keep away from financial mess possible during a medical disaster. The fact is that all insurance plans have exclusions which are medical conditions and illnesses that almost all insurers decline to cover. Being alert of these exclusions will allow the potential policyholder to purchase the proper health insurance policy, and know which medical conditions are not covered.

Common Exclusions in Health Insurance Plans

Common Exclusions of Health Insurance Plans

It is vital to go through all the details of the policy before buying, and this can help you understand some of the top most common exclusions.

1. Pre-Existing Diseases

If the policyholder is suffering from any illness then it will be considered in pre-existing diseases that are not covered as insurance is done for uncertain things. A waiting period of two to four years or more is there based on the kind of illness and its hazard if the insurer agrees to include it. Diseases that are pre-existing such as kidney stones, cataracts, few chronic diseases, arthritis, diabetes, cardiac problems, joints treatment, and more are some which can be excluded.

2. Pregnancy-Related Conditions

This is one of the most common exceptions in medical insurance plans. Pregnancy and other related conditions such as abortion, regular checkups, childbirth, etc. are not covered under a general health insurance policy. Pregnancy is a critical condition for most ladies. Hence, it is suggested that the plan documents are read carefully to learn about the exclusions in detail before buying.

3. Cosmetic Surgeries

Cosmetic processes are meant to improve the appearance of an individual’s face and other body parts. Thus, this does not fall under the group of a medical emergency, which means that it cannot be covered in a health insurance plan. But, they are covered only when suggested by a registered medical practitioner following an accident and injury. Moreover, joint replacement surgeries and dental treatment are also part of the exclusions of health insurance plans.

4. Therapies and Alternative Treatment

Some individuals like alternative methods of treatment on finding no respite from their regular allopathic treatment. The special treatments include naturopathy, acupressure, Ayurveda, and magnetic therapy, etc. None of these forms of treatment is covered under medical health plans.

5. Injuries because of Intentional Harm and Suicide Attempt

Injuries and sufferings caused by deliberate harm/attempts to finish one’s life are not included under any health plan. This is an essential factor to be remembered at all times.

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As health insurance policies differ from one another it is important that you read the documents very carefully before buying. It will give clearness about what is included and what is not included in the health insurance plan. Choose a complete policy with vital add-ons such as, cover for serious illness, post and pre-hospitalization rather than a basic one as this will help you get the best benefits.

Disclaimer: This article is issued in the general public interest and meant for general information purposes only. Readers are advised not to rely on the contents of the article as conclusive in nature and should research further or consult an expert in this regard.

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