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Find out what your health insurance covers and what it doesn't.

Published On Mar 30, 2022, Updated On Apr 05, 2022

In general, medical insurance policies would exclude certain conditions from coverage for the first year and then cover them once the waiting period expired. Certain common exclusions apply, such as the cost of contact lenses, glasses, and hearing aids, which are not covered. Dental surgery/treatment, congenital external deformities, convalescence, venereal illness, general debility, use of intoxicating drugs/alcohol, self-inflicted injuries, AIDS, diagnostic fees, infertility therapy, and Naturopathy treatment are also excluded from Indian health insurance policies.

What does health insurance not cover?

Here's a list of diseases and therapies that aren't covered by health insurance.

  • Procedures for Cosmetic Enhancement

Botox, Liposuction, implants, and other equivalent operations are not covered by health insurance. If you want to have such surgery within the insurance period, you must tell your insurer. Insurance companies will not pay for such medical procedures unless they are included in the therapy.

  • Previously existing illnesses

Pre-existing conditions and the associated waiting periods vary by insurance provider. Diabetes, high blood pressure, cardiac patients, and other conditions may be covered by some insurance providers. Most health insurance policies would reimburse such expenses only after a waiting period of 12 to 48 months. New health plans, on the other hand, are being developed that incorporate PED coverage from the start. In certain situations, in return for a higher premium, the insurer will cover pre-existing conditions.

  • Infertility and pregnancy complications

Health insurance does not cover hospitalization expenditures linked with infertility/pregnancy concerns, such as abortions. Certain maternal health policies may pay these expenses, but they are not covered by standard health insurance. Examine the policy wordings if you are specifically looking for coverage for pregnancy-related expenses. You can also investigate women's health.

  • Health Supplements

Under your health insurance policy, the insurer does not provide financial coverage for health tonics and supplements. If the treating physician recommends them, the costs may be reimbursable. However, if you take it without a prescription, your insurer will not pay it. More information may be found in the policy wordings.

  • Excessive Alcohol Consumption-Related Diseases

If you have a condition that is connected to excessive alcohol consumption, such as liver damage or other problems, your health insurance provider may deny your claim.

What Is Health Insurance Covered For?

Some of the most frequent diseases covered by health insurance policies are as follows:

  • Cancer

Cancer is one of the most frequent and deadly diseases in today's world. Cancer affects many people as a result of fundamental changes in modern lifestyle or medical history. Many health insurance policies cover cancer at all stages and offer a second medical opinion to aid in the diagnosis of this critical ailment. The claim amount for such diseases is granted to policyholders in the form of a lump sum payment to help them compensate for the loss of income caused by the disease's treatment.

  • Blood Pressure Is Excessive

Many people have high blood pressure as a result of increasing work stress and other medical factors. Untreated high blood pressure over time can develop a blockage in the blood vessels, resulting in a heart attack or stroke. As a result, it is vital to seek early medical care for blood pressure problems, which may be easily performed with the help of a health insurance plan.

  • Diabetes

Diabetes is a condition in which the patient's blood sugar levels are greater than normal, and untreated diabetes can lead to stroke, heart attack, kidney failure, and other consequences.
With the help of a health insurance plan and its wide coverage, you may acquire proper diabetic medical treatments without worrying about financial constraints.


To avoid a poor experience and better manage your finances, study your policy wordings thoroughly to have a better grasp of both the inclusions and the conditions that are not covered by health insurance.

Also read- In A Health Insurance Policy, There Are A Few Key Terms To Know.

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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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