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List of Diseases Not Covered Under Health Insurance
Mar 30, 2021

List of Diseases Not Covered Under Health Insurance

A health insurance policy covers unforeseen medical emergency costs, but there are some limitations to which diseases it can cover and what it is not. Therefore, health insurance tends to be more complicated for ordinary people when they are not aware of the terms and conditions. Shreya, a twenty-five-year-old woman, loves to party every other day with her friends and her lifestyle includes alcohol and smoking. One night after the party, Shreya fell unconscious and was admitted to the hospital. Her report says she is suffering from immune system dysfunction due to too much alcohol in the body that causes an alteration in her platelets, white and red blood cells. To cover her hospitalization expenses, Shreya was counting on her health insurance policy. However, she was disappointed to know that her health insurance policy company rejected her claim because health issues due to the consumption of drugs, alcohol, and smoking are not covered in her health insurance policy. Thus Shreya was not entitled to the compensation and had to pay the expenses from her pocket. To avoid such misconceptions in the future, the policyholder should know more about which diseases are not covered in health insurance and understand health insurance coverage better; read this article to know the list of diseases not covered under health insurance.

List of diseases not covered in health insurance

The IRDAI (Insurance Development Authority of India) has standardized some omissions in a health insurance policy to ensure rigid adherence to rules.

Congenital Diseases/Genetic Disordered

Congenital diseases or genetic disorders are conditions of a person present in the body by birth. It is further categorized as external congenital such as extra skin formation, etc., and internal congenital such as weak heart since birth. A health insurance company doesn’t cover any of these diseases.

Cosmetic Surgery

Cosmetic surgery such as botox, facelift, breast or lip augmentation, rhinoplasty, etc., are the ways to enhance the beauty and physical attributes of a person and are not considered indispensable to maintain quality of life or ensure body function. Hence it is excluded from a health insurance policy.

Health issues due to consumption of drugs, alcohol, and smoking

There’s no denying that drug addicts or smokers, or regular alcohol drinkers are more prone to lifestyle diseases than other people. Some severe diseases like stroke, mouth cancer, liver damage, bronchitis, etc., are the effects of high consumption of drugs, smoking, or alcohol. The health insurance policy has completely excluded claims under these circumstances.

IVF and Infertility Treatments

Due to IVF and other infertility treatments are planned events and involving a high sum amount. Therefore, the health insurance policy is only covered by medical emergency due to unforeseen circumstances hence the expenses related to any infertility treatment are not covered in the policy.

Pregnancy Treatment

The health insurance policy does not cover any pregnancy treatment due to complications of cesarean section.

Voluntary Abortion

India has restricted laws for abortion services; thus, voluntary abortion expenses are not covered by the health insurance policy.

Pre-existing Illnesses

A health insurance policy doesn't cover any undergoing surgery or diagnosis of diseases whose symptoms first occur within 30 days or existing before purchasing the policy, also know as the waiting period.

Self-Inflicted injury

Health insurance policy does not cover any injuries caused due to any self-attempted or suicide attempts. Health insurance policy does not cover any damages caused due to any self-attempted or suicide attempt.

Transmitted disease

There are limited health insurance policies in India covering transmitted diseases such as HIV, Sexually Transmitted Diseases (STD), gonorrhea, etc., with restricted period or amount. As the treatment for these diseases are prolonged and require the cure for the entire life, hence it is making it costlier for the health insurance company to cover

Permanent Exclusions

Hospitalization expenses for the injuries caused due to war, riots, nuclear weapon attack, strike are not covered in a health insurance policy and are considered permanent exclusions.


1. Why does the health insurance provider exclude some claims?

Because in some cases, the risk is enormous and involves a large sum of amount for a more extended period, hence it is excluded.

2. Which other treatments are generally included in health insurance plans?

Alternative treatments such as Homeopathy, Ayurveda, Acupressure, etc., are only covered under plans offering AYUSH treatment.

Final Thoughts

The clauses under the inclusions/exclusions sections can significantly vary from one health policy insurance provider to another. Still, the list of diseases not covered under health insurance is the same with each insurer to ensure equal attention. Before purchasing a health insurance policy, ensure you are fully aware of the clauses and the terms and conditions so that you can make the best use of it.

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