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Permanent exclusions in health insurance are diseases and medical conditions that are permanently excluded from the cover offered by the policy. The list of permanent exclusions is given by the Insurance Regulatory and Development Authority of India. Some of the permanent exclusions include sarcoidosis, chronic liver disease, hepatitis B and Alzheimer's Disease. You cannot raise a claim for conditions that are classified as permanent exclusions, because insurers will not cover them. Get to know more about these exclusions in this article.

Important Update (Dated May 30, 2024) – Good news for Health Insurance policyholders! According to the Master Circular on Health Insurance Business 29052024 rolled out on May 29, 2024 by IRDAI, insurers are to decide on the request for cashless claims within 1 hour of receiving the request. Also, the final claim is to be granted within 3 hours after the policyholder’s discharge from the hospital. Insurers have been directed by IRDAI to establish necessary systems and procedures for this process by July 31, 2024.

 

The Master Circular on Health Insurance Business 29052024 circular is available here - https://irdai.gov.in/document-detail?documentId=4942918

List of Permanent Exclusions in Health Insurance

Here is the list of diseases as declared by the IRDAI that are considered permanent exclusions in a health policy:

 

  • Sarcoidosis

  • Malignant Neoplasms

  • Epilepsy

  • Heart Ailments; Congenital heart disease, Valvular heart disease

  • Cerebrovascular Disease

  • Inflammatory Bowel Diseases

  • Chronic Liver Diseases

  • Pancreatic Diseases

  • Chronic Kidney Disease

  • Hepatitis B

  • Alzheimer’s Disease

  • Parkinson’s Disease

  • Demyelinating Disease

  • HIV and AIDS

  • Loss of Hearing

  • Papulosquamous Skin Disease

  • Avascular Necrosis

Note: In order to ensure that people who have these diseases as pre-existing conditions get adequate coverage, the IRDAI also recommends that insurers can add these diseases under ‘inclusions’ of their plans for those specific policyholders. The IRDAI also mentions that the policyholders must be made aware of the fact that these diseases have been added as ‘inclusions’ under their policy when changes to the policy terms are made by the insurer.

Other Common Exclusions in Health Insurance

Apart from the list of diseases mentioned above, there are also some other common diseases/medical conditions which are termed exclusions in health insurance. Let’s take a quick look at them:

 

  • Pre-existing health conditions

  • Infertility

  • Injuries/illnesses that result from illegal activities

  • Injuries suffered as a result of engaging in adventure sports

  • Addiction treatments

  • Dental treatments (unless the dental injury results from an accident)

  • Genetic disease/Congenital conditions

  • Cosmetic treatments

  • Treatment for self-harm

  • Alternative therapies

Note: This is a general list of common exclusions. Some health insurance providers may provide coverage for some of these conditions in their plans, as the list of inclusions varies under different insurers. Refer to the insurance policy document provided by your health insurer to understand the full scope of your health plan’s inclusions and exclusions.

Conclusion

It is common knowledge that health insurance has become a necessity for everyone. Given the rising healthcare costs and rampant medical inflation, health insurance remains the most effective financial tool to combat these costs. However, you need to consider many factors if you are planning to buy health insurance.

 

Most importantly, you should understand the inclusions and exclusions of the policy clearly so that you know exactly what kind of medical conditions and diseases you will be covered for. If you are looking to buy a new health insurance plan for yourself and your family, you can check out the range of health insurance plans available at Bajaj Markets. 

FAQs on Permanent Exclusions in Health Insurance

What are the diseases that are ‘Permanently Excluded’ under health insurance?

The IRDAI has created the following list of diseases that insurers can permanently exclude from their insurance plans:

  • Sarcoidosis

  • Malignant Neoplasms

  • Epilepsy

  • Heart Ailments; Congenital heart disease, Valvular heart disease

  • Cerebrovascular Disease

  • Inflammatory Bowel Diseases

  • Chronic Liver Diseases

  • Pancreatic Diseases

  • Chronic Kidney Disease

  • Hepatitis B

  • Alzheimer’s Disease

  • Parkinson’s Disease

  • Demyelinating Disease

  • HIV and AIDS

  • Loss of Hearing

  • Papulosquamous Skin Disease

  • Avascular Necrosis 

Is there any way to get coverage for the diseases that are listed as ‘permanent exclusions’?

In case you have one of the ‘permanently excluded’ diseases as a pre-existing condition at the time of buying your insurance policy, the insurer may choose to voluntarily offer you coverage for your condition.

Are pre-existing diseases considered exclusions under health insurance?

Yes, most pre-existing diseases are initially considered exclusions under health insurance until the waiting period for them has passed. Once the waiting period gets over, you can get coverage for your pre-existing conditions. 

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