The General Exclusions That You Must Know in Your Health Insurance Policy

The General Exclusions That You Must Know in Your Health Insurance Policy

The General Exclusions That You Must Know in Your Health Insurance Policy


Rushing into a medical insurance policy without carefully reading its exclusions can get you into difficulty later on. Every policyholder should be aware of the exclusions in health insurance policies before purchasing a plan. Most of you worry about having a health insurance claim denied. Although we recognise that this can be intimidating, there is a very easy strategy that can be used to prevent the denial of a health insurance claim.

The key is to carefully read your policy document so that you are aware of the coverage, features, perks, SI (Sum Insured) you selected, and exclusions of your health insurance policy. Having a smooth claim settlement procedure depends on you being aware of certain basics regarding your coverage.

Your claim will be rejected right away if you submit it for a procedure that is not covered by your health insurance plans for family(is an exclusion). We also don’t want this to occur to you. So, in order to avoid any issues while submitting a health insurance claim, below are some typical exclusions of your health insurance policy that you should be aware of:

  1. Pre-existing ailments: Prior to the start of your health insurance coverage, conditions including heart disease, kidney disease, diabetes, cancer, and more, are not covered. They have a waiting period, and once that time has passed, coverage for the same begins. Each insurance provider has a different pre-existing condition waiting time that might range from one to three years.
  2. Alternative therapies: Alternative therapies are covered by insurance policies. They include insurance for hospitalisation, including Ayurvedic and homeopathic treatments. However, health insurance policies do not cover other treatments like naturopathy, acupuncture, magnetic therapy, acupressure, etc.
  3. Cosmetic procedures: Unless the surgery is prescribed by a medical practitioner in response to a serious incident, such as deformity caused by an accident or a serious sickness, such as cancer, health insurance coverage do not cover cosmetic surgeries (plastic surgeries), hair transplants.
  4. Dental procedures: Only accidental damage to your natural teeth, subject to hospitalisation, is covered by health insurance policies. All additional dental procedures are typically not covered by health insurance programmes.
  5. Self-inflicted injuries: Your health insurance will not pay for any treatment you receive for a self-inflicted injury. Additionally, no health insurance plan will pay for injuries brought on by suicide attempts that could leave the victim incapacitated or damaged. Additionally, your coverage does not cover injuries sustained in times of conflict.
  6. Other illnesses and treatments: Other illnesses and treatments, such as those related to HIV, contagious diseases, the use of drugs or alcohol, treatments for addiction, procedures relating to fertility, experimental treatments, etc., are not covered by health insurance.
  7. Mandatory waiting period:The majority ofmedical insurance policies exclude coverage during this time, which can last anywhere between one and three months. Accidental injuries, however, are covered as soon as your health insurance coverage begins.
  8. Pregnancy: Pregnancy, childbirth, vaccination, and similar expenses could not be covered by your policy. Additionally, there may be a 1-2 year waiting period for pregnancies. After this waiting time, you can start receiving respectable benefits if you’re considering having a child.

It’s best to first become familiar with the different kinds of medical insurance policies and the benefits of health insurance. You must carefully read the exclusions before purchasing any insurance coverage. Additionally, you can read our in-depth brochures for each of our health insurance plans on our website, where you can learn about both the general and individual exclusions. As we previously indicated, it is crucial to understand the exclusions of your health insurance policy so that you do not run into difficulties while submitting a claim.

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Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms, and conditions, please read the sales brochure/policy wording carefully before concluding a sale.


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