Which Diseases Are Not Covered Under Health Insurance?

Having good health insurance for yourself and your family members is extremely crucial as the cost of healthcare in India has jumped exponentially over the past few years. The COVID-19 pandemic has also proven to be an example of why people should mandatorily have health insurance. Even minor treatments or hospitalisations at reputed private hospitals can cost lakhs of rupees if you are not medically insured. However, you should also consider health insurance exclusions and diseases that are not covered before buying a policy.

Some diseases and conditions that may not be covered by your health insurance includes -

1. HIV/Aids and other sexually transmitted diseases

2. Infertility

3. Injuries/illnesses that result from illegal activities

4. Injuries suffered as a result of engaging in adventure sports

5. Addiction treatments

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

7. Genetic Disease/Congenital conditions

Disclaimer: All insurance plans have their own separate list of exclusions, so some of the above diseases may very well be covered in certain plans but excluded in others.

Disease Not Covered Under Waiting Period

Although most health insurance plans cover a wide majority of diseases, there are certain illnesses that are not covered for the first few years. Given below is the list of diseases not covered under health insurance but come with a waiting period -

1. Gastrointestinal Ulcers

2. Any forms of fistula

3. Benign Prostatic hypertrophy

4. Any types of sinuses

5. Haemorrhoids and Piles

6. Dysfunctional Uterine bleeding

7. Endometriosis

8. Pancreatitis

9. Cataracts

10. Macular Degeneration

11. Hernia

12. Fibromyoma

13. Hysterectomy

14. Cirrhosis

15. Tonsillitis

16. Mental illnesses like Alzheimer’s and Dementia

What are Health Insurance Exclusions?

The Insurance Regulatory and Development Authority of India (IRDAI) has a list of diseases/medical that are not covered under health insurance:

• Cosmetic Surgeries

Any expense related to cosmetic surgery is not covered in the policy. These include Liposuction, Botox, or any similar kind of surgery. This is unless a doctor prescribes any plastic surgeries or hair transplants following a grave incident such as deformation caused in an accident or due to critical health conditions.

• IVF and Fertility Treatment

Most general health insurance providers also do not offer coverage for IVF procedures or fertility treatments.

• Pregnancy and Abortion

Many health insurance plans in India do not cover medical expenses arising due to pregnancy and abortion.

• Miscellaneous Charges

Other charges such as registration charges, admission fees, and service charges related to 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.

• Alternative Therapies

Usually, health insurance plans do not cover Ayurvedic and Homoeopathic treatments. Treatments such as naturopathy, acupuncture, magnetic therapy, acupressure, etc. are not covered under the policy. Check for health insurance at Bajaj MARKETS as the policy covers Ayurvedic and Homoeopathic treatments under it.

• Pre-Existing Health Conditions

Pre-existing diseases 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.

• Self Harm

Health insurance also does not cover any injuries or medical issues arising from a person causing themselves harm.

Waiting Periods vs Exclusions

Many people who look into buying health insurance may become confused between the ‘waiting period’ and ‘exclusions’. Let us understand both of these terms briefly.

In terms of health insurance, a ‘waiting period’ refers to a time frame of a few months or years where the health insurance provider does not provide coverage for pre-existing conditions. For e.g., if an individual has diabetes as a pre-existing condition and applies for health insurance, the health insurance policy will typically have a waiting period of a few months or years where treatment for diabetes will not be covered. However, once the waiting period is over, the insurer will start providing coverage for diabetes.

On the other hand, exclusions are certain diseases or medical conditions that are not covered by the health insurer at all, under any conditions. When you look at exclusions in a health insurance plan, these are medical issues that the insurance will not cover throughout the full term of the policy.

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 are the premiums charged, coverage of the plan, claim settlement ratio of the insurer, etc. Based on the evaluation, you can then choose a health insurance policy from Bajaj MARKETS that best suits your needs.

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