Compare & Buy Car, Bike and Health Insurance Online - InsuranceDekho
Claim, renew, manage & moreLogin

Know What Is Covered And Not Covered Under A Health Insurance Policy

Published On Feb 05, 2022

In the health-care business, medical advances and technology have lowered the number of fatalities while increasing the rate of recovery. Medical inflation, on the other hand, is due to advancements in medical knowledge. Hospitalisation, treatment, and medication expenditures are burning a hole in people's finances. That is why purchasing the appropriate health insurance coverage is a good move. However, you should review the coverage of a health insurance policy before purchasing it to ensure that you get the most out of it.
As a consequence, before selecting a health plan, it is advised that you do your investigation and plan ahead of time. It will help you choose a health insurance policy with the fewest exclusions and the broadest coverage. Furthermore, medical insurance policies frequently exclude certain illnesses from coverage for the first year, only to cover them once the waiting period has ended. To understand and know more about the coverage of health insurance, read on.

Know What Is Covered And Not Covered Under A Health Insurance Policy

Importance of Health Insurance

We should all purchase health insurance for ourselves and our families, based on our individual requirements. Purchasing health insurance protects us from the unexpected expenditures of hospitalisation (or other covered health occurrences such as severe diseases), which might otherwise deplete household finances or potentially lead to debt. Each of us is exposed to a variety of health risks, and a medical emergency can strike anybody at any time.

What Does A Health Insurance Policy Exclude?

Following are the things not covered under health insurance policies -

COSMETIC SURGERIES - Cosmetic procedures such as Botox, Liposuction, implants, and other comparable procedures are not covered by health insurance. If you want to have such surgery within your insurance term, check with your insurer first. Such medical procedures are not covered by insurance companies unless they are part of the therapy.

PRE-EXISTING ILLNESSES - Pre-existing conditions and the waiting periods that come with them differ from one insurance provider to the next. Some insurance companies may cover diabetes, high blood pressure, heart disease, and other disorders. Most health insurance policies would only reimburse such payments after a waiting period, which might be anywhere from 12 to 48 months. On the other hand, new health plans are being established that cover PEDs from the start.

HEALTH SUPPLEMENTS - The cost of health tonics and supplements is not covered by your health insurance policy. If the treating physician approves it, the expenses may be reimbursable. If you take it without a prescription, though, your insurance will not pay it.

OFF-LABEL PRESCRIPTIONS - Prescription drugs are assessed and approved for particular disorders, such as autoimmune diseases. These drugs are occasionally used for illnesses that aren't listed on the "label." In some cases, the insurance company may refuse to pay for these off-label treatments. By submitting peer-reviewed research, physicians may occasionally persuade insurance companies to pay for off-label pharmaceuticals for certain purposes, although insurance companies are not obligated to do so.

FERTILITY COMPLICATIONS & TREATMENT - Health insurance does not cover hospitalisation expenditures related to infertility and pregnancy complications, such as abortions. These costs may be covered by certain maternal health insurance policies, but they are not covered by basic health insurance. Review your policy's wordings if you're looking for coverage for pregnancy-related expenses. You might also check into women's health insurance to assist cover these expenses.

NEW TECHNOLOGY IN PRODUCTS & SERVICES - It can take a long time to recoup these expenditures, especially if the technology does not provide a clear advantage in exchange for the higher costs. Medical companies must show that a new treatment, product, or test provides a significant benefit to the consumer that justifies the cost by reducing death or morbidity rates (basically, save lives or reduce ill health). Because Medicare is a late adopter of new technology, other insurance plans are more likely to follow suit and wait for further information before adding it into authorised coverage.


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

Also read- Reasons Why You Should Consider Health Insurance While Planning For A Safe Future

Understanding Multiple Benefits Of Health Insurance During COVID -19 Pandemic

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.

Health Insurance Coverage Calculator

Who do you want to insured ?

  • Individual
  • Couple
  • Family
  • Parents

Age of eldest insured member ?

Where do you live ?

Disclaimer : Actual Coverage might vary basis your location, age and number of members
Must BuyMust Buy

Why to Buy Health Insurance Policy Online from InsuranceDekho

  • Tax benefit upto 75,000*
  • Claim support everyday 10AM-7PM
  • 50 Lacs+ happy customers