Exclusions and Waiting Period: Know Them Before Choosing a Health Policy
Published On Sep 23, 2019 5:30 AM By Prashant Srivastava
Treatment costs are skyrocketing.
When a medical emergency strikes, you’re left with no option than using funds from your savings, which not just impacts your financial health, but personal goals as well.
Therefore, health insurance has become the need of the day.
A health insurance offers unending benefits, such as:
- It saves you from putting a big dent in your savings
- It offers you the convenience of instant cashless treatment
- It covers the expenses incurred before and after hospitalisation
That is not all. Major benefits of buying health insurance plan are that it helps you save tax and have a higher take-home pay as a result. And of course, nobody wants to lose it.
In order to truly enjoy your life without thinking about financial setbacks, choose the best health insurance policy for you and your family today.
However, choosing the right health policy is what actually matter. You need to be careful enough about the insurance jargons like Exclusions and Waiting Period to reap the most out of your policy.
Let’s discover in deep the Exclusions and the Waiting Period.
Exclusions are the factors to consider when choosing a health policy. However, people tend to overlook this part and end up in disappointment while claiming.
Here is a list of exclusions that are usually excluded from the policy.
Lifestyle Health Issues - Unless you pay an additional premium, lifestyle-related diseases are excluded. Some of these health issues are obesity, diabetes, etc.
Pre-existing Conditions - Pre-existing medical conditions are those that develop before you buy the policy. These diseases are not covered initially. A lock-in period of 2-4 years is given to cover such medical conditions.
Alternative Treatment - Not every insurance company provides coverage for alternative treatment, which includes AYUSH (Ayurvedic, Yoga and Naturopathy, Unani, Siddha and Homeopathy) treatment. However, those providing the cover for alternative treatment comes with a condition that the treatment should be taken at a government or recognised institution.
Cosmetic/Plastic Surgery - Cosmetic or plastic surgeries are excluded unless it is due to an accidental injury. Similarly, expenses incurred for dental treatment are not covered unless it is a case of an accident.
Pregnancy and Newborn- Not all insurance companies cover pregnancy and newborn or childbirth expenses.
Suicide or Suicidal Attempts - Intentional injuries like suicide or attempt to suicide with a purpose to harm yourself are not included in the cover.
Dental, Hearing, and Vision - Health insurance companies don’t cover dental, hearing and eye procedures that don’t require hospitalisation. But, the treatment that comes under daycare procedure is covered.
Also read: Personal Health Insurance vs Corporate Health Insurance
Apart from the above EXCLUSIONS, there are some diseases and incidents which are permanently excluded. They are:
- Injuries due to civil commotion, war or use of a nuclear weapon or warlike situation
- Expenses incurred in the treatment of congenital disease, AIDS/HIV or related diseases, etc.
There are a few insurance companies that provide cover for HIV. It is advisable to have checked the list of exclusions before zeroing down on a plan.
After understanding exclusions, let’s discuss the WAITING PERIOD.
What is the Waiting Period?
The concept of the waiting period is very simple.
It’s a particular span of time within which certain diseases are not covered, except the accidental case.
With the waiting period in place, insurance companies reduce the chances of fraudulent activities and stop policyholders from misusing the coverage.
In general, four main types of the waiting period are applied in health insurance in India:
Initial Waiting Period: The days of initial period vary from insurer to insurer. Usually, it ranges between 30-90 days from the inception of the policy. Within this period, the insurer doesn’t accept any claim. The objective of this period is to restrain customers from making a claim immediately after buying the policy in case he or she is diagnosed with a serious illness.
Pre-existing Waiting Period: The waiting period for pre-existing diseases may be from 1 year to 4 years. If any medical emergency strikes within this period due to a pre-existing illness, the claim is not entertained. This means that any complications arising out of the pre-existing diseases are covered only after the specific waiting period is served.
Maternity Waiting Period: Only a few insurance providers offer maternity benefits as an in-built cover. This cover can be opted as an add-on. But, it also comes with a waiting period of 9 months to 4 years. Further, you can’t take this policy once you conceive.
Waiting Period for Specific Illness: Some illnesses are not covered soon after the policy is purchased. These diseases are hernia, ENT disorders, osteoporosis, or the diseases specified in the policy. Generally, the waiting period for these is 2 or 3 years.
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The bottom line is that you should know about exclusions and waiting period under the policy. Understand the coverage. Go through the clauses and terms and conditions. If you ignore these, the situation will turn upside down for you.