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.

What is Not Covered in Your Health Insurance Policy

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:

1. 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.

2. 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.

3. 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.

4. Dental Expenses

Other than dental surgery due to an accident, any other dental costs are not covered by a health insurance policy.

5. Cosmetic Surgeries

Health insurance service providers do not cover any cosmetic surgeries.

6. Rehabilitation Treatments

All rehabilitation treatments or ‘Rest Cure’ are not provided any coverage by medical insurance policies.

7. Acupressure Treatments

Any unproven treatment options such as Acupressure is not enlisted for coverage in a health insurance policy.

8. HIV Treatments

Your health insurance service provider won’t offer you coverage for HIV treatments

9. 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.

10. Circumcision

Men undergoing circumcision would be unable to pass any claim for coverage even in a full coverage health insurance plan.

11. 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!

Health & Fitness