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Learn what your health insurance does and does not cover.

Updated On Mar 14, 2022

Generally, medical insurance policies would exclude specific ailments from coverage during the first year and cover them once the waiting period was finished. There are certain typical exclusions, such as the cost of contact lenses, glasses, and hearing aids, which are not covered. Dental surgery/treatment (unless hospitalization is required), 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 also excluded from Indian health insurance plans.

What does health insurance not cover?

Here is the following list of the diseases and treatments that are not covered by health insurance.

  • Cosmetic Procedures

Cosmetic treatments such as Botox, Liposuction, implants, and other comparable procedures are not covered by health insurance. If you want to have such surgery within the policy period, you should notify your insurer. Insurance companies do not cover such medical treatments unless they are part of the therapy.

  • Illnesses that existed previously

Pre-existing conditions and accompanying waiting periods differ from one insurance provider to the next. Some insurance companies may cover diabetes, high blood pressure, cardiac patients, and so forth. Most health plans would cover such costs only after the waiting period, which can be anywhere from 12 to 48 months. However, new health plans are being introduced that include PED coverage from the start. In some cases, the insurer will cover pre-existing conditions in exchange for a higher premium.

  • Complications of infertility and pregnancy

Hospitalization costs associated with infertility/pregnancy issues, such as abortions, are not covered by health insurance. These fees may be reimbursed by certain maternity health policies, but they are not covered by basic health insurance. If you are especially searching for coverage for pregnancy-related expenditures, you can examine the policy wordings. You can also look into women's health.

  • Supplements for Health

The insurer does not give financial coverage for health tonics and supplements under your health insurance policy. If the treating doctor recommends them, the expenditures may be reimbursable. However, if you take it without a prescription, it will not be covered by your insurer. You may find more information in the policy wordings.

  • Diseases Caused by Excessive Alcohol Consumption

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

What Does Health Insurance Cover?

The following are some of the most common ailments that insurers cover under health insurance plans:

1. Cancer

Cancer is one of the most common life-threatening diseases in today's globe. Many people are affected by cancer as a result of fundamental changes in modern lifestyle or medical history. Many health insurance policies cover cancer at all stages of the disease and also provide a second medical opinion to help with the diagnosis of this crucial condition. The claim amount for such diseases is provided to policyholders in a lump payment to assist them to compensate for the loss of income caused as a result of the disease's treatment.

2. High Blood Pressure

Many people are suffering from blood pressure problems as a result of increased working stress and other medical causes. Untreated high blood pressure over an extended period of time can cause a blockage in the blood arteries, resulting in a heart attack or stroke. As a result, it is critical to seek early medical care for blood pressure difficulties, which can be accomplished without difficulty with the assistance of a health insurance plan

3. Diabetes

This is an illness in which the patient's blood sugar levels are higher than usual, and uncontrolled diabetes can lead to stroke, heart attack, renal failure, and other complications.
With the aid of a health insurance plan and its extensive coverage, you may obtain appropriate medical treatments for diabetes without worrying about financial limits.


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: Understanding Health Insurance Policies in General

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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