About List of Diseases Not Covered Under Health Insurance

The importance of health insurance in our lives is beyond explanation. Many people only focus on the cost of the policy and its coverage. One main thing that people forget taking into consideration is the exclusions of health insurance plans in India.

Let us consider an example for a better understanding.

Nisha and Tarun have been married for a couple of years. Recently, they decided to start a family and have been trying for it ever since. However, Nisha was diagnosed with a critical infertility condition for which her gynaecologist suggested a surgery.

The couple thought that since they have a health insurance plan under their name, the expenses of the treatment and surgery will be well taken care of. With this mindset, they started with Nisha’s treatment at a top infertility centre in the city.

But to their disappointment, the claims made on their health insurance were rejected by the insurer. Because of the rejected claims, the couple had to face financial turmoil caused due to the treatment and surgery. Later, the couple realised infertility treatments are not covered under their insurance plan and are mentioned explicitly in the exclusions by the insurer. Hence, the claims made towards it were rejected.

The above example reinstates the importance of knowing the health insurance exclusions when buying the policy. Let us take a look at some standard health insurance exclusions.

Health Insurance Exclusions

The following is a list of standard things that are not covered under health insurance plans in India.

  • Pre-Existing Health Conditions: Pre-existing health conditions are not covered under health insurance right away. Certain plans do not provide cover for high blood pressure and diabetes, while many others do. The insurer will provide a waiting period after which the claims for the pre-existing health conditions can be made. The waiting period depends on the insurer and can be between 12-48 months.
  • Cosmetic Surgeries: Any expense related to cosmetic surgery is not covered in the policy. These include Liposuction, Botox, or any similar kind of surgeries. Unless a doctor prescribes any plastic surgeries or hair transplant following a grave incident such as deformation caused in an accident or due to critical health conditions.
  • Alternative Therapies: Usually, health insurance plans do not cover for Ayurvedic and Homeopathic treatments. Treatments such as naturopathy, acupuncture, magnetic therapy, acupressure, etc. are not covered under the policy. Check for Health Insurance at Finserv MARKETS as the policy covers Ayurvedic and Homeopathic treatments under it.
  • Pregnancy and Abortion: Many health insurance plans in India do not cover medical expenses arising due to pregnancy and abortion. However, Health Insurance plans at Finserv MARKETS cover maternity and newborn expenses under the policy. Know that voluntary abortions are not covered under any health insurance plans.
  • Miscellaneous Charges: Other charges such as registration charges, admission fees, and service charges related to the medical treatment are not covered under certain health insurance plans.
  • Health Supplements: Health supplement costs and protein shake expenses are not covered under health insurance in India. One has to pay these from their pocket.

The Need for Health Insurance Exclusions

While exclusions tend to narrow the scope of the health insurance coverage, they are quite essential. The following pointers will help you understand the need for health insurance exclusions –

  • It helps understand and be mindful of the risks that the insurers in India are not willing to reimburse for
  • A few risks are uninsurable as they tend to impact several people at once – for instance, war and natural calamities
  • A few medical treatments and expenses can be quite manageable and hence do not need coverage under a health insurance plan

Exclusion of Health Insurance Plans available on Finserv MARKETS

The following are the exclusions of health insurance plans available on Finserv MARKETS online.

  • Three years of the waiting period will be applicable in case of pre-existing illnesses
  • Diseases arising in the first 30 days of the policy are not covered
  • Medical expenses incurred due to criminal activities, suicide or self-injuries
  • Medical care or hospitalization needed due to war or war-like situations
  • Medical attention required when under the influence of alcohol and other intoxicants
  • For sexually transmitted diseases like AIDS
  • For participating in naval, military or air force operations or dangerous sports like racing and driving.
  • Mental disorders
  • Although Maternity/New-born baby expenses are covered, they have a waiting period of six years
  • Medical emergencies arising due to consumption of intoxicants and/or addictive substances like drugs, alcohol, etc. are not covered

To Conclude    

You must understand the health insurance coverage and exclusions correctly before buying the policy. That way, you will be able to make a successful claim on your health insurance plan. Other things that you can consider when buying health insurance is the premiums charged, coverage of the plan, claim settlement ratio of the insurer, etc. Based on the evaluation, you can then choose a policy that best suits your needs.

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