Find Out What Your Health Insurance Does And Does Not Cover.
Published On Jun 07, 2022 10:00 AM By InsuranceDekho
Table of Contents
- List of Diseases Covered under Health Insurance
- Exclusions Under A Health Insurance Policy
It is suggested that you do your research and planning before selecting a health plan. It will help you choose a health insurance policy that has minimal exclusions and offers maximum coverage. Furthermore, medical insurance plans would generally exclude certain illnesses from the first year of coverage and cover it after the waiting period is over.
There are certain standard sets of exclusions like the cost of contact lenses, spectacles, and hearing aids that are not covered. Also, dental surgery/ treatment ( unless requiring hospitalization), congenital external defects, convalescence, venereal disease, general debility, use of intoxicating drugs/alcohol, Self-inflicted injuries, AIDS, diagnosis expenses, infertility treatment, and Naturopathy treatment make a list of exclusions under health insurance plans in India.
List of Diseases Covered under Health Insurance
Let us have a look at what are the 36 critical illnesses that almost every critical illness plan offers cover for-
1. Heart attack
2. Heart valve replacement due to defects or abnormalities
3. Coronary artery diseases requiring a bypass or other surgery
4. Aorta surgery via thoracotomy or laparotomy
7. Kidney failure
8. Fulminant viral Hepatitis or massive necrosis of liver caused by a virus which can lead to liver failure
9. Major organ transplant including Kidney, Lungs, Liver, Heart and Bone marrow
10. Paralysis or Paraplegia including the complete and permanent loss of one or all of the limbs
11. Multiple sclerosis
12. Primary pulmonary Arterial Hypertension
13. Total and/or permanent blindness
14. Total and/or permanent deafness
15. Total and/or permanent loss of speech
16. Alzheimer’s disease or other degenerative brain disorder
17. Parkinson’s disease
19. Third-degree burns covering at least 20% of the surface area of the body
20. Terminal illness
Exclusions Under A Health Insurance Policy
Read to know more about the list of diseases/treatments that are not covered under a health insurance plan:
Cosmetic surgeries like Botox, Liposuction, implants and similar surgeries are excluded from a health insurance policy. You can check with your insurer if you plan to undergo any such surgery during the policy term. Unless it is a part of the treatment, insurance companies do not compensate for such medical procedures.
Pre-existing diseases and related waiting periods vary from one insurance company to another. Some insurance providers may provide cover for diabetes, blood pressure, heart patients, etc. Most of the health plans would include such expenses only after the waiting period is completed, which can range from 12 months to 48 months. However new health plans are being launched that provide PED cover from Day 1.
And in some cases, the insurer will cover pre-existing diseases on payment of additional premiums.
Infertility/Pregnancy related complications
Hospitalization expenses related to infertility/pregnancy complications like abortions are excluded from health insurance coverage. In some maternity health plans, these expenses can be covered, but in basic health plans, these expenses are not covered. You can check your policy wordings if you are specifically looking for coverage for pregnancy-related expenses. You can also check out women specific health plans to cover such expenses.
Under your health insurance policy, the insurer does not provide financial cover for health tonics and supplements. If these are recommended by the treating doctor then the expenses might be claimable. But if you are taking it without any prescription then it shall not be a part of policy coverage. For details, you can refer to the policy wordings.
Diseases related to Overconsumption of Alcohol
If any illness is tracked to overconsumption of alcohol like liver damage, and other problems, then the insurance company holds the right to reject your health insurance claim.
Expenses incurred on Alternative Therapies
Any expenses that you incur on alternative therapies like naturopathy, acupressure, naturopathy, acupuncture, reflexology, and similar expenses are excluded from health insurance coverage.
Any expense incurred on diagnostic or pathological services like scans, blood tests, and other body tests performed at a nursing home or hospital are excluded unless the policy covers them specifically or it is required as a part of the treatment.
So, to avoid going through such a negative experience and manage your finances better, read your policy wordings till the end to have better clarity on both the inclusions and. the diseases that are excluded from health insurance scope of coverage.
Also read- Advantages Of Star Health & Allied Insurance's Senior Citizens Red Carpet Policy
What Exactly Is a Comprehensive Health Insurance Policy?