9 Common Health Insurance Exclusions You Should Know About

9 Common Health Insurance Exclusions You Should Know About

Bajaj Finserv Health
January 07, 20225 mins read

Key Takeaways

  • The IRDAI has issued guidelines for health insurance cover exclusions
  • Lifestyle-related ailments and pregnancy are among the excluded conditions
  • Read the policy terms and conditions carefully to take an informed decision

Purchasing a health insurance policy doesn’t mean that it will cover all your medical conditions. Your health insurance cover may not include certain illnesses or procedures because of their nature or causes. It is better for you to do research and comparisons before finalizing a plan. This will help you avoid inconveniences or rejection when filing a claim. For better uniformity and transparency, IRDAI has issued guidelines for medical conditions whose cover is not included in a policy. Read on to know more about the common in your health insurance exclusions.

9 Common Health Insurance Exclusions:-

Cosmetic surgeries

A health policy usually doesn’t cover cosmetic surgeries like facelift, Botox, and lip or breast augmentation. This is because they are not considered necessary to maintain your quality of life. Instead, they are usually done to enhance physical attributes. Your health insurance coverage may not include these unless it is a part of your treatment. 

Health conditions related to lifestyle 

Certain disorders or addictions make you more prone to health conditions. Habits like smoking, alcohol addiction, or substance abuse may lead to critical conditions which your health policy may not cover. In case you make a claim, there will be a high chance of it getting rejected. Common lifestyle-related ailments which a health policy doesn’t cover include

  • Liver damage
  • Mouth cancer
  • Stroke

However, if your condition is not caused by lifestyle disorder, you may dispute the decision of your insurer.

feature of health insurance

Pre-existing medical conditions

Pre-existing diseases are the ones diagnosed before your policy comes into effect. Some insurers may not cover such pre-existing ailments. Some companies offer coverage for them but only after you complete the waiting period. Depending on the insurer, this period can vary between 12 and 48 months. Other companies offer a cover only after an additional payment. Here are the usual pre-existing conditions this applies to.

Additional Read: Pre-existing Diseases Health Insurance

Transmitted diseases

Your health insurance exclusion may include cover for transmitted diseases like STDs on account of prolonged and extensive treatment. The common transmitted diseases not covered by a health policy are as follows.

  • AIDS
  • Gonorrhea
  • Chlamydia
  • Syphilis

However, some health insurance policies may include treatment of a few of such ailments. So, make sure you read the terms and conditions carefully when buying a policy.

Maternity and abortion expenses

Usually, a health insurance cover doesn’t include pregnancy or abortion expenses. Even if there is a complication or you get a C-section, your policy may not cover its costs. For such coverage, look for insurers who offer women-specific plans that cover expenses related to pregnancy. Some companies even allow a maternity cover in your policy as an add-on. This may increase your premium amount but allows you to remain stress-free. If an abortion is performed in compliance with MTP Act, your policy may cover the expenses. [1]

Infertility treatments

Treatment for infertility is usually planned and comes with a high cost. That is why some health insurance providers do not include this under their policies. There are some plans specific for women that may include cover for such treatments. Compare different policy documents carefully to make an informed decision.

 Health Insurance Exclusions You Should Know -13

Health supplements

Expenses for your health supplements and tonics may not be a part of your health insurance cover. However, if you are taking them as per the advice of your doctor, you may be able to make a claim. However, these expenses may not be included in your policy without a prescription. So, read the terms before filing a claim. 

Alternate therapies and wellness services 

Usually, your health insurance cover may not include the following.

  • Comfort treatments such as sauna, naturopathy, steam bath, oil massages, and more
  • Treatment availed at a spa, salon or wellness clinic, which are not hospitals

Today, due to the rise in demand, your insurance provider may cover alternate therapies like acupressure and acupuncture. You may also find some policies that provide cover for AYUSH treatments. Talk to your insurance provider to get a clear idea about the inclusion of alternate therapies.

Other charges

Depending on your insurance provider, your health insurance cover may not include the following expenses.

  • Registration charges
  • Admission fees 
  • Service charges 
  • Diagnostics charges

Some insurance companies also exclude certain ailments like 

  • Cataract 
  • Hernia 
  • Sinusitis
  • Joint replacement
  • Age-related diseases
Additional Read: Dental Insurance

As per regulations, the standard exclusions from your health insurance cover include the following [2].

  • Cost of spectacles or contact lenses
  • Hearing aids
  • Dental treatment and dental surgery (covered if hospitalized)
  • Intentional injury caused by self
  • Expenses of tests that do not lead a hospitalization 

However, do remember that you can always change your policy if your current plan does not cover your needs. It is also important that you read the terms and conditions carefully before buying a policy. This is because the exclusions may vary from company to company. Reading the terms will help you better understand what is excluded and included in your health insurance cover

For higher coverage, consider the Aarogya Care Complete Health Solution plans available on Bajaj Finserv Health. They are both comprehensive and affordable to suit your needs better. Their health insurance coverage includes lab tests expenses, doctor consultations, and has no hidden costs. This way you can select the best health policy for your loved ones and yourself.

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  1. https://www.irdai.gov.in/admincms/cms/Uploadedfiles/NATIONAL15/Naini
  2. https://www.policyholder.gov.in/you_and_your_health_insurance_policy_faqs.aspx

Please note that this article is solely meant for informational purposes and Bajaj Finserv Health Limited (“BFHL”) does not shoulder any responsibility of the views/advice/information expressed/given by the writer/reviewer/originator. This article should not be considered as a substitute for any medical advice, diagnosis or treatment. Always consult with your trusted physician/qualified healthcare professional to evaluate your medical condition. The above article has been reviewed by a qualified doctor and BFHL is not responsible for any damages for any information or services provided by any third party.

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