Health Insurance Exclusions
  • Identify the Exclusions of your Policy
  • Understand the Limitations before Buying
  • Explore the Waiting & PED Clause

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Health Insurance Exclusions

Health insurance offers financial protection to an individual or their family during a medical crisis. A potent Health Plan pays off the hospital and other medical-related bills and ensures that you concentrate on recovery and not on the bills.

Generally, Health Insurance policies cover most common illnesses, however, every Health Insurance Plan comes with its own set of Exclusions. These Exclusions can be defined as certain kinds of medical conditions/ specific circumstances that are not provided compensation against, or some diseases which are covered only after a specific waiting period.

Not knowing about these Exclusions often causes disappointment and distress at the time of a medical emergency. Therefore it is always advisable to thoroughly read your policy documents before buying a Health Insurance policy and understand the Exclusions.

Health Insurance Exclusions vary from company to company, however, in this article, we have mentioned a list of common Health Insurance Exclusions. Read along to find out.

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Common Exclusions in Health Insurance

  1. Waiting Period Clause

    Every Insurance Company has its own specific set of certain ailments & illnesses that are not covered until the waiting period is waived off. A policyholder needs to wait for a particular pre-defined time period to start availing of the benefits of the plan.

    In simple words, during the waiting period, one cannot make any medical claim. Only after the successful completion of the Waiting Period period, a policyholder can avail of all the benefits of the policy.

  2. Pre Existing Diseases (PED)

    A Pre-Existing disease is any sort of illness that a policyholder has been facing before buying a Health Insurance policy. Every Health Insurance Company has a waiting period depending upon the type of disease, which may range from 2-4 years or more.

    Generally, diseases like Cataract, Arthritis, Congenital Diseases, Cosmetic Surgeries, etc are excluded.

  3. Maternity Related Expenses

    If you are planning to start a family, then it’s important to verify if your Health Insurance plan offers coverage for maternity-related expenses such as childbirth, prenatal and postnatal care, newborn baby cover etc.

    Most Health Insurance providers cover maternity expenses after a waiting period of 1-2 years, which means that you can avail of the benefit only after completing the waiting period. However, it is advised to carefully read about the coverage of Maternity Expenses in your policy brochure. However, it is advisable to carefully read about the coverage of Maternity Expenses in your policy brochure.

  4. Mental Illness

    Mental Health conditions such as Depression and Anxiety are generally excluded from Health Insurance policies. However, you can check the same with your Insurance Provider for a clearer understanding.

  5. HIV/AIDS

    Health Insurance doesn’t cover sexually transmitted diseases (STD’s).

  6. Cosmetic Treatments

    Cosmetic treatments such as Plastic Surgery, Breast Enhancement, Body Contouring are usually not covered under a standard Health Insurance Plan.

  7. Dental Treatment

    Under most plans, Dental procedures are not covered unless the need for Dental treatment arises out of accidental injuries.

  8. Deliberate Injuries

    Self-inflicted injuries or any sort of injuries or illnesses that occur due to attempted suicide are not covered under Health Insurance.

  9. Permanent Exclusions

    Congenital diseases or damages due to war and nuclear weapons are permanently excluded from the Health Insurance policies.

Conclusion

You must not make a quick decision while purchasing a plan. First, consider yours and your family’s health needs and make an analysis of what should be included in your plan, and thereafter, select the most appropriate plan.

Every Health Insurance company has its own list of Exclusions. Before choosing any Health plan, you must go through the policy brochure properly. If the need arises, you must get in touch with the company to understand what a particular plan would offer & cover. Understanding what is not covered under your policy is as important as understanding what is covered under the chosen plan.

Knowing everything about your policy will not only help you to budget for out of pocket expenses but will also make the claim settlement process easier.

Written By : Naval Goel

Last Updated : Sept, 2021

Naval Goel is the CEO & founder of PolicyX.com. Naval has an expertise in the insurance sector and has professional experience of more than a decade in the Industry and has worked in companies like AIG, New York doing valuation of insurance subsidiaries. He is also an Associate Member of the Indian Institute of Insurance, Pune. He has been authorized by IRDAI to act as a Principal Officer of PolicyX.com Insurance Web Aggregator.

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