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Guide to What's Not Covered in a Health Insurance Plan
Jan 13, 2023

Common Exclusions in a Health Insurance Policy

Life is unpredictable and any uncertainty can happen at any point in time. A health insurance policy offers financial protection in case of any medical crisis or emergency. A planned financial cushion becomes imperative as it would help to pay the medical costs that otherwise would hit the hard-earned savings. Health insurance coverage may vary from insurer to insurer. While buying the insurance plan, ensure to look for inclusions and exclusions offered within the plan. If you file for an insurance claim against any ailment that is not covered, the insurance company would straight away reject it.

What Does ‘Exclusion’ Mean in a Health Insurance Plan?

Every health insurance comes with its set of inclusions and exclusions. In a health insurance plan, exclusions refer to the specific medical conditions that remain uncovered by the insurance company. As it remains uncovered the insurance company is not liable to pay for the expenses incurred due to the same. To save yourself from any surprises, ensure to read the policy wording carefully. There are times when a specific disease or illness may not get covered at the beginning of the policy. However, once the waiting period gets over for the specified, a cover is offered. This may vary from insurer to insurer. *Standard T&C apply

Know the Common Exclusions Under a Mediclaim Insurance Policy

Now, that you know the meaning of exclusions. Let's have a look at the below-mentioned common exclusions within a mediclaim policy. But before that, remember the exclusion list will vary from one policy to another. It implies that what may get covered under an individual health plan may not be covered within a senior citizen health insurance plan.

1. Pre-existing Diseases/Ailments

Any medical ailment or condition that the policyholder is suffering at the time of purchasing the health insurance policy is referred to as a pre-existing disease condition. It mostly remains uncovered in the insurance plan. Yet, some of the ailments may get covered after the specified waiting period gets over depending upon the type and risk.

2. Substance Abuse/Alcoholism

Any expenses incurred to treat for any illness or injury due to consumption of alcohol or other substance abuse remains uncovered.

3. Cosmetic Treatment

Any cosmetic treatment like plastic surgery also remains uncovered by the medical insurance plan. It is to be noted in the case due to an accident if cosmetic treatment is required medically it gets covered.

4. Maternity-related Expenses

In case you are thinking to start a family, it is better to check if maternity-related expenses remain covered or not. These expenses include pre and post-natal care, etc. There are health insurance companies that provide maternity coverage after a waiting period gets over.

5. Deliberate Injury or HIV AIDS

A self-inflicted injury or illness due to an attempt of suicide also is not covered under a regular health insurance plan. If an individual injures themselves deliberately leading to permanent or total disability will also be uncovered. Generally, a mediclaim policy also does not offer a cover for any sexually transmitted diseases. *Standard T&C apply

Wrapping it Up

As prudent as it is to have a health insurance policy in place, it is equally important to know the entire policy completely before signing. If you have immediate dependents consider the option of choosing health insurance for the family at a cost-effective premium. Before you make a final decision, understand the needs and accordingly make an informed decision. The inclusions and exclusions offered within a policy will vary from insurer to insurer. Go through the policy documents carefully as it enables you to be prepared for any medical exigency.     *Standard T&C apply 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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