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Buying A Health Insurance Policy? Know What Diseases Are Excluded

Adhil Shetty
Image source: xb100 / Freepik

High medical inflation and unforeseen medical emergencies make it a necessity for everyone to own health insurance. An adequate health insurance plan has the potential to ease financial stress due to any medical emergency like surgery or any other serious ailment. Before buying a health insurance policy, assess your needs after factoring in the health of immediate family members. It would be wise to compare the benefits and features offered by various insurance providers, and choose one which offers the best protection in what will be financially difficult times. Also look up the insurer’s claim settlement ratio. Besides these, another important thing you should be aware of is the type of treatment and medical conditions your health insurance policy will not cover.

Why Understanding The Exclusions Is A Must

While buying a health insurance policy, we often tend to skip over the fine print of the insurance document. We may also not take the time to understand the various clauses, only to get a rude shock later. Pre-existing diseases, sub-limits, exclusions are important aspects of a health insurance policy to get the complete settlement. The Insurance Regulatory and Development Authority of India (Irdai) last year updated the list of diseases that are permanently not included in the health insurance policy.

17 Permanent Exclusions

IRDA’s standardised list of 17 permanent exclusions includes epilepsy, congenital heart disease, cerebral stroke, chronic liver and kidney diseases, hepatitis B, Alzheimer’s, Parkinson’s, HIV and AIDS, loss of hearing, and physical disabilities. It also said that the insurers cannot deny cover for diseases such as Alzheimer’s, Parkinson’s, AIDS/HIV infection, morbid obesity if they are contracted after buying a health cover. Besides these permanent diseases, also take a look at the list of health conditions and treatment that will not be covered by a health insurance policy.

Alternative Therapies And New Techniques

Not all health insurance policies cover alternative treatments under Ayurveda, Naturopathy and Unani, and similar lines of treatment such as magnetic therapy and acupressure may also not be covered. However, some new insurers have started covering alternative medicine as well, though such coverage is typically more expensive than more basic plans. Experimental or recently launched treatments—for example, robotic surgery—may also not be covered.

Cosmetic Surgery

Fat reduction surgeries or liposuction, botox treatment, cosmetic surgeries or any other surgery of similar nature are not covered by health insurance. Dental treatments are also not covered as they are considered cosmetic.

Pre-existing Diseases

Ailments, which you may have had before taking a health insurance policy, like high blood pressure, diabetes etc. are not immediately covered by most insurance companies. However, these may be covered after a waiting period ranging from a few months to four years. The waiting period depends on the disease, and the terms and conditions vary from one insurer to another.

Treatment For Alcohol Or Drug Abuse & Self Harm

Alcohol or drug use can lead to health complications. Any medical conditions arising out of the use of alcohol and drug consumption will therefore not be covered. If coverage is denied on these grounds, you could always contest it as the insurer has to establish causation between the health condition and the use of alcohol or drugs. Also, health problems arising out of attempted suicide or deliberate self-harm will not be covered.

The First 30 Days

For all health insurance policies, no coverage is provided in the first 30 days except in the case of treatments necessitated by accidents.

Before you go for hospitalization, also check if the doctor’s visit charges are included in the room rent as some hospital tend to segregate this. To enjoy the benefits of a medical insurance policy, it is crucial to understand the terms and conditions to know the inclusions and exclusions.

The author is CEO, BankBazaar.com