Medical insurance is a long-term policy that covers essential hospitalization for illness and accidents till you become old and in many cases all your life.
Even though a health insurance policy works best to provide you an assured sum or financial assistance in case of any unforeseen situations related to your health, it does not cover many things.
In the context of the same, let’s provide you some vital exclusions of a full coverage health insurance.
30-Day Cool Off Period
If you are diagnosed with any condition or diseases within the first 30 days of enrolling in any normal or best health insurance policy, they are not covered.
1. Some Specific Surgeries are Excluded
Some policies open coverage for the following ailments/surgeries from 3rd year onwards:
- Hydrocele surgery (male scrotum)
- Hernia
- Arthritis
- Cataract
- Enlarged prostate BPH surgery
- ENT disorders
- Hysterectomy
- Anus fistula
- Piles
- Sinus
- Gallbladder surgery
- Gout
- Rheumatism
- Hypertension
- Diabetes
- Stones
- Slipped disc
- Joint replacement
- Varicose veins
- Osteoarthritis
- Genito-urinary system
- Osteoporosis
2. Pre-Existing Conditions
You should also know that all diagnosed diseases and symptoms, declared and undeclared conditions have a waiting period of 4 years and they are covered after that. However, for some specific diseases or ailments, a pre-existing condition may not apply.
Permanent Exclusions in Medical Insurance
There is some permanent exclusion even if you have availed the best insurance plan such as:
3. When You Get Hospitalized For Evaluation Purposes
Even a full coverage health insurance plan won’t provide you any coverage if you have availed a policy and get hospitalized just for evaluation purposes. Any medical insurance will not pay you the expenses for the purpose; you will need to pay out of your pocket.
4. OPD Treatments
All kinds of Out-Patient Department (OPD) treatments based fees have to be borne by you. Your health insurance policy won’t cover it at all.
5. Maternity and Childbirth Expenses
Many medical insurance plans have provision to cover maternity expenses after 3-4 years of the policy purchase. These kinds of expenses may or may not be covered and depend on your policy clauses.
6. Dental Expenses
Other than dental surgery due to an accident, any other dental costs are not covered by a health insurance policy.
7. Cosmetic Surgeries
Health insurance service providers do not cover any cosmetic surgeries.
8. Rehabilitation Treatments
All rehabilitation treatments or ‘Rest Cure’ are not provided any coverage by medical insurance policies.
9. Acupressure Treatments
Any unproven treatment options such as Acupressure is not enlisted for coverage in a health insurance policy.
10. HIV Treatments
Your health insurance service provider won’t offer you coverage for HIV treatments
11. STDs Treatments
If you are diagnosed with any of the Sexually Transmitted Diseases (STDs), you won’t be able to apply for a claim with your existing medical insurance company.
12. Circumcision
Men undergoing circumcision would be unable to pass any claim for coverage even in a full coverage health insurance plan.
13. Service Charges and Registration Fees in a Hospital
Many people are confused if their medical insurance policy covers service charges and registration fees or not. Be informed to know that these charges are excluded in a health insurance scheme.
The Bottom Line
You should be feeling well-informed after getting to know what’s excluded in your medical insurance policy. Being well-informed on this will now help you know the limits of a policy, and you will arrange for funds for these exclusions well in advance!
Punit