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What Does Health Insurance Not Cover?

Always ask your insurance agent to inform you about things that are usually not covered in health insurance. Read this article for a list of 6 aspects excluded in a health insurance plan.

  • Nov 30, 2021

Health insurance plans give financial respite during critical illness, abrupt surgery, or a medical emergency. Health insurance plans from different service providers vary in the offered coverage, benefits, and riders. As an alert policy buyer, you should understand the offerings and the exclusions of the health insurance plans to avoid misinformation.

Though for the sake of uniformity, the Insurance Regulatory and Development Authority of India (IRDAI) has standardized health insurance plan exclusions, ask your insurance agent to inform you about things that are usually not covered in health insurance.

Here is a list of 6 aspects excluded in a health insurance plan –

1. Pre-existing Diseases

Already existing diseases are generally not covered in a new medical insurance plan. Some service providers may include pre-existing diseases like diabetes or high blood pressure but only after the waiting period is over, which could typically range between 2-5 years. Some of the health insurers may cover pre-existing diseases at the cost of an extra premium.

2. Pregnancy & Miscarriages

Pregnancy and miscarriages are not a part of health insurance plans. The charges meted for pre-natal, cesarean surgery, or post-natal care is to be borne separately by the policyholder. Abortion is also generally excluded until it is involuntary and crucial for the survival of the mother. If needed, the case is presented to the insurance company under the reference of the certified medical team. However, some plans give coverage to maternity benefits subjected to conditions.

3. Supplements & Stimulants

The cost of health supplements and stimulants does not fall under health insurance plans that are not part of the doctor’s recommendation for combating any covered disease. A health insurance plan covers only those tonics and supplements that are prescribed by the treating doctor.

4. Cosmetic Surgery

Though cosmetic surgeries like injecting botox, liposuction, etc., have become very common these days, they are not yet part of any medical insurance plan. They are generally expensive and taken voluntarily for enhancement of looks. Still, if the treating medical practitioner recommends the need for cosmetic surgery in critical accident cases, a health insurance plan may cover it, subject to their conditions.

5. Dental Procedures

Dental procedures are excluded from health insurance plans, especially if they are for cosmetic enhancement. However, if dental treatment is part of some critical surgery and crucial for a patient’s life, your insurer might consider it on the doctor’s recommendation and under relevant terms and conditions.

6. Non-Medical Miscellaneous Charges

Hospitalization involves many non-medical expenditures ranging from registration fees, admission charges, ambulance charges, service charges, etc. These are unavoidable and still not covered in the health insurance policies.

Be Aware

Awareness is primary while buying a health insurance plan. If the technical terms of the insurance world are confusing, ask your health insurance agent to list the policy exclusions. They may vary between plans and insurers, thus deserve your close attention and understanding before the purchase.

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Ref. No. KLI/22-23/E-BB/2435


- A Consumer Education Initiative series by Kotak Life

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