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Get To Know What Your Health Insurance Does Not Cover

Published On Jan 20, 2022, Updated On Jan 28, 2022

There are certain typical exclusions, like contact lenses, spectacles, and hearing aids, which are not covered. Dental surgery/treatment (unless requiring hospitalisation), congenital external defects, convalescence, venereal disease, general debility, use of intoxicating drugs/alcohol, self-inflicted injuries, AIDS, diagnosis expenses, infertility treatment, and Naturopathy treatment are among the exclusions covered by Indian health insurance plans.
As a result, it is recommended that you do your homework and plan ahead of time before choosing a health plan. It will assist you in selecting a health insurance policy with the fewest exclusions and the most comprehensive coverage. Furthermore, medical insurance policies would often exclude specific ailments from coverage during the first year and then cover them when the waiting time has passed. To understand more about health insurance coverage, read on.

Get To Know What Your Health Insurance Does Not Cover

Cosmetic Surgeries

Health insurance does not cover cosmetic operations like Botox, Liposuction, implants, and other similar procedures. If you plan to have such surgery within the insurance period, you should verify with your insurer. Insurance companies do not cover such medical treatments unless they are part of the therapy.

Pre-Existing Illnesses

Pre-existing conditions and their associated waiting periods vary by insurance company. Diabetes, high blood pressure, heart disease, and other diseases may be covered by some insurance providers. Most health plans would cover such payments only after the waiting period, which can be anywhere from 12 to 48 months, has passed. New health plans, on the other hand, are being introduced that cover PEDs from day one.

Fertility Complications & Treatment

Hospitalisation costs connected to infertility and pregnancy difficulties, such as abortions, are not covered by health insurance. Certain maternal health insurance policies may pay these expenditures, but they are not covered by basic health insurance. If you're seeking coverage for pregnancy-related expenditures, review your policy's wordings. You may also look into women's health policies to help pay these costs.

Health Supplements

The insurer does not pay the cost of health tonics and supplements under your health insurance coverage. The charges may be reimbursable if the treating physician recommends them. However, if you take it without a prescription, it will not be covered by your insurance.

Diseases Related To Excessive Alcohol Intake

If any condition is linked to excessive alcohol intake, such as liver damage or other issues, the insurance provider has the ability to deny your health insurance claim.

Expenses For Alternative Therapies

Health insurance does not cover alternative therapies including naturopathy, acupressure, naturopathy, acupuncture, reflexology, and other comparable treatments.

Diagnostic Charges

Diagnostic or pathological services, such as scans, blood tests, and other bodily testing, conducted at a nursing home or hospital are not covered unless the policy expressly covers them or they are necessary as part of the therapy.

Off-Label Prescriptions

For certain conditions, such as autoimmune diseases, prescription medications are evaluated and authorised. These medications are sometimes administered for conditions that aren't stated on the "label." The insurance provider may refuse to pay for these off-label usage in specific situations.
Physicians can sometimes persuade insurance companies to pay off-label medications for certain applications by presenting peer-reviewed evidence, but insurance companies are not compelled to do so.

New Technology In Products And Services

Covering these costs can take a long time, particularly if the technology does not offer a clear benefit in return for the increased costs. Medical firms must demonstrate that a new medicine, product, or test delivers a meaningful benefit to the customer that justifies the expense by lowering death or morbidity rates (basically, save lives or reduce ill health). Because Medicare is a late user of new technology, other insurance plans tend to follow suit and wait for additional data before incorporating it into approved benefits.


So, to avoid a bad experience and better manage your funds, read your policy wordings all the way through to get a better understanding of both the inclusions and the ailments that are not covered by health insurance.

Also read- Importance of Getting Health Insurance That Covers Home Treatment

Protect Yourself from Omicron

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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