Know what is not covered under your health insurance plan to ensure your claim is not rejected

With increasing medical costs, rise in the number of diseases and high inflation rate, having a health insurance policy has become mandatory. Adequate health insurance can ease the financial burden during a medical emergency, if it arises. However, while selecting a health insurance plan, you must ensure that the policy covers your specific needs.

Insurance advisors suggest that one must opt for a policy that best suits their needs and offers support at times of medical emergencies in case of hospitalisation and/or treatment.

Often health insurance buyers do not read the fine print before investing in a policy. They then, end up having to bear expenses of various medical requirements that are not covered under the policy. Hence, it is necessary to check all inclusions, exclusions and limitations of a policy before buying it.

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Although, it is mandatory for health insurance companies to provide a list of exclusions under their plans that are in adherence to the guidelines issued by the Insurance Regulatory and Development Authority of India (IRDAI). Nonetheless, an insurer can reject claims arising for hospitalisation related to the specific list of diseases that are not covered by health insurance.

Let's take a look at some common exclusions in health insurance policies.

If an individual is suffering from any ailment while applying for insurance, it is not covered under the health insurance policy. This is because health insurance covers the risk of uncertain events and not the ones that already exist. However, pre-existing conditions are covered after a waiting period of two to four years or more, depending on the type of disease and its risk.

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Health insurance policies do not cover cosmetic surgeries as they are not vital medical procedures and are not considered life-threatening. Hence, liposuction, botox or surgeries of a similar nature are not covered under a health insurance policies. However, costs of plastic surgery following an accident or injury are covered in certain policies.

A health insurance policy does not cover medical expenses during pregnancy, childbirth or abortion. A few health insurance policies, called Maternity insurance plans, offer coverage, but with limitations. The policies have a waiting period of one to two years. So, any expenses related to pregnancy or childbirth during the waiting period will not be covered under the policy. Also, maternity insurance does not cover the medical expenses for the birth of a third child.

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Health insurance plans do not cover dental conditions as they do not require hospitalisation. However, dental treatment expenses are covered in case of an accidental injury.

If any injury occurs from an act of self-harm or suicide attempt, a health insurance policy will not cover it.

A health insurance policy does not cover charges incurred for a pathological surveillance such as blood tests and CT scan. Moreover, there are standard sets of exclusions which are not covered in health policies like the cost of contact lenses, spectacles and hearing aid.