Common Exclusions In Health Insurance
Updated On Jul 06, 2021
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A health insurance policy comes packed with a lot of benefits for its customers. You can avail of these benefits whenever required at the time of an emergency. These benefits commonly include pre and post-hospitalization, domiciliary expenses, in-patient hospitalization expenses, medical consultations, etc. But, it is to be noted that there is are some exclusions in the health insurance policy purchased which should be taken into consideration to avoid any confusion at the time of claim settlement in case of an emergency.
During the free-look period of the health insurance policy which is usually 15 days, you must carefully examine the inclusions and exclusions in your policy to make sure that your requirements are met and everything that you demand has been included in your health insurance policy. The benefits in the policy are included and excluded based on the type of plan chosen by the policyholder, sum assured, premium rate, the requirement of the policyholder, and much more.
Common Exclusions of A Health Insurance Policy
The excluded features of a health insurance policy differ from one policy to the other. But, there is a set of features that are excluded from mostly all the health insurance plans that you purchase from any insurer in the insurance market. Let us look at the basic exclusions of a health insurance policy:
Waiting Period Clause
Under this clause, the benefits of a health insurance policy purchased cannot be availed for a specific period of time mentioned by the insurer in the policy documents. This waiting period ranges from 1 month to 3 years. It differs from one policy to the other. Therefore, before purchasing a health insurance cover you must confirm the waiting period of the policy with the insurer. It is usually for the pre-existing diseases covered under the health insurance policy.
There is a list of pre-existing diseases that are covered under a health insurance policy. Pre-existing diseases are disorders that a policyholder is already suffering from. It is usually covered with a waiting period of 1 to 2 years considering the risks involved in it. Diseases like cataracts, kidney stones, arthritis, chronic diseases, etc can be excluded.
Pregnancy is not covered under regular health insurance plans. For this, you can buy a separate maternity insurance plan. However, if you buy a cover for maternity benefits while you are pregnant, then it is considered a pre-existing disease with a waiting period. In such cases, it will not bear any fruits, and therefore you must be a little early in purchasing a maternity benefit plan. You can buy it as soon as you plan a baby.
Different types of surgeries like joint replacement, cosmetic surgery, dental surgeries, etc are not covered under your purchased health insurance plan. Cosmetic surgeries are meant to improve the appearance of the individual’s face or any body part. Cosmetic surgeries can be covered on the recommendation of a medical expert in case of an accident or injury.
Certain conditions like injuries in war, HIV, intentional injuries, injuries due to suicide attempts, etc are excluded from the health insurance policies as these are done willingly and therefore, are not the case of an accident or emergency. A health insurance cover looks after the medical expenses of the conditions that occurred due to any unforeseen events.
Treatments like Ayurveda, homeopathy, etc are not taken care of under a regular health insurance policy.
There are sub-limit provisions on the expenses incurred on room rents, ambulance charges, doctor fees, etc. That is, a portion of the medical bill will be taken care of by the policyholder. Therefore, you must carefully read the sub-limit clause to be prepared in case of an emergency.
It is important that you stay aware of the exclusions in your health insurance policy as they help you to stay prepared for mishaps and avoids any confusion while settling the claims.
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.