When you buy a health insurance plan for yourself and your loved ones, you will notice that your insurer hands you over a list of exclusions on which you won't be getting any coverage. These exclusions are in accordance with the guidelines of IRDAI or the Insurance Regulatory and Development Authority of India.

So, in case you raise a claim for any of the diseases which are mentioned in the exclusion list, your health insurance company has the right to reject your claims. Hence, it is necessary that while you buy a health insurance plan, research well about the list of diseases not covered under health insurance.

When you plan well and gain adequate knowledge about the exclusions, you will be in a better position to opt for a health insurance policy that caters to your and your family's needs aptly.

What Health Insurance Doesn't Cover?

Following are some treatments and conditions which health insurance does not cover. Let us dive deeper and get the exact details!

  • Pre-Existing Illnesses: When it comes to pre-existing illnesses, you will always need to take confirmation from the insurer whether or not it offers coverage on specific diseases. Generally, the majority of the health insurance policies provide coverage to health conditions like blood pressure, diabetes, heart diseases, etc., after the completion of the waiting period. The waiting phase may last from 12 to 48 months. However, a few insurance companies are there which cover these health issues from day 1.
  • Cosmetic Surgeries: Know that different types of cosmetic surgeries, such as liposuction, Botox, implants, etc., are not covered by health insurance policies. But if you are planning to undergo any such surgery, you can discuss the issue with your insurance provider. But in general, a health insurance company won't be compensating you for such medical expenses.
  • Health Supplements: Another thing which your health insurance does not cover is the expenses that you incur while buying health supplements and tonics. This is so because you are intaking these medicines at your own behest. However, if your treating doctor recommends you these health supplements, then you can place a claim for the expenditures. In case you fail to produce your prescription for such supplements, then your insurer won't consider it as a part of the health insurance policy.
  • Pregnancy, Abortion, or Infertility-Related Health Conditions: If you are going to plan your family in the upcoming years, you should know that a health insurance company does not cover the expenses incurred because of pregnancy, abortion, or infertility. If you want apt coverage for these health conditions, you need to buy a maternity plan as well, besides your basic health insurance plan.
  • Charges Related To Diagnostics: Pathological or diagnostic services like blood tests, scans, and other body tests generally do not come under the coverage of health insurance plans. Your insurer will cover them only when those tests are specifically included in the policy or are a prerequisite for your ongoing treatment at the hospital.
  • Health Conditions That Arise Because of Overconsumption of Alcohol: If you or your loved one consumes too much alcohol, and your health condition deteriorates because of excessive intake of alcohol, then your insurer will not cover the expenses for such diseases.
  • Expenses Regarding Alternate Therapies: If you are fond of alternate therapies like naturopathy, acupressure, reflexology, acupuncture, etc., then know that your expenses won't be compensated by your insurance company.
  • Miscellaneous Charges: Admission fees, registration charges, and service charges do not come under health insurance plan coverage.

FAQs - Frequently Asked Questions

Q1. What do you mean by exclusions in health insurance plans?

Certain diseases do not come under the coverage of health insurance policies. Those health conditions are considered exclusions in health insurance policies.

Q2. Does dental replacement come under a health insurance policy?

No, dental replacement does not get coverage from health insurers.

Q3. My wife has some infertility issues, and the treatment involves huge expenditure. Can I claim the compensation?

Unfortunately, health insurance companies do not cover infertility-related expenses. You need to buy maternity plans well in advance if you wish to get such coverage.

Q4. I just bought a few hair care supplements from the drugstore. Can I include the expenses in my ongoing treatment claim?

Unfortunately, this is not possible. If your hair care supplements are not a part of your ongoing treatment and you fail to produce the prescription, then these expenses won’t be covered by your health insurance company.

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