What is normally not covered in health insurance plans? Let’s find out
Health insurance has attained grave importance in today’s times. However, most people buy health plans assuming that any and all health circumstances are covered by the policy. This is not true: every health plan has a set of exclusions that one must be aware of while buying it.
The following is a list of exclusions in most health insurance plans in India. However, there may be exceptions to this list based on the insurance plan you buy and the insurance provider you work with, so please refer to the policy document in detail before making your purchase:
* Coverage under personal accident insurance: Though personal accident insurance plans cover loss of limbs, broken bones, partial/temporary disability arising out of an accident and a range of accidents, they do not cover injuries that are self-inflicted or arising out of a suicide attempt. Nor do they cover injuries that result from participation in dangerous sports, or working with police or armed forces, mining work, etc. Injuries arising out of accidents caused by driving inebriated are also not covered.
* Alternative, non-Allopathic treatments: Though several reputed health insurance policies in India do offer coverage for AYUSH treatments, many still do not. These are treatments that use alternative medicine (Ayurvedic, Unani, Siddha, Homeopathy, Acupuncture, Naturopathy, etc.) while the health coverage is extended to Allopathic and conventional treatments only. Another important area of exclusion is ‘experimental procedures’. These are new age surgeries using technology or expertise that are not yet allowed by health insurers, such as robotic surgery.
* Non-essential procedures: Non-essential procedures are classified as those that are not life threatening, or which do not directly improve one’s health. These are normally clubbed under cosmetic and dental procedures, where surgeries are undertaken to improve one’s looks. These are usually not covered by Indian health insurance, or if they are, then they are subject to certain conditions. However, if the same are carried out to improve the appearance after a person has undergone accidental injury, then the insurance provider might process the claim subject to certain provisos. Similarly, dental surgery claims may be entertained if the procedure is performed to correct a life-threatening condition and/or requires 24-hour hospitalisation.
* Pre-existing diseases: Most health insurance plans in India do not cover pre-existing ailments, especially of a certain severity and if a person has had them for over 10 years. The pre-existing illness must mandatorily be declared while purchasing the health plan. Suppose the health policy does offer coverage for your specific illness, there will still be a long waiting period for it (sometimes up to 4 years, depending on the nature and duration of the illness).
* Lifestyle diseases and others: Health policies normally does not cover diseases caused by poor lifestyle choices. Though the illness may be of a serious nature, from kidney damage to lung diseases, these may have been caused by alcohol or nicotine consumption. Most insurers also do not cover congenital diseases, injuries sustained due to war situations and HIV/AIDS.
* Pregnancy and childbirth costs: Reputed health insurance providers offer coverage for hospitalisation and surgery related to pregnancy complications and childbirth, but several do not. The coverage may be offered with a certain waiting period. Check-ups, diagnostic tests, abortion surgeries and fertility tests are often excluded. The policy document will give you a full list of exclusions in this regard.
* Diagnostic tests: These are generally excluded unless the test is positive for a listed critical illness, or if the claim is filed against critical illness insurance.
