Health Insurance Exclusions
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  • Explore Health Plan limitations
  • Explore PED Clause
Health Insurance Common Exclusions
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Health Insurance Common 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, 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 you have the Best Health Insurance plan covering 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.

Permanent Exclusions in Health Insurance

Generally, health insurance policies cover most of the common illnesses, however, every health insurance plan comes with its own set of exclusions. These can be some common exclusions that may or may not be included in the policy depending on the insurer, permanent exclusions in health insurance which are always ruled out from health policies or they can be conditional exclusions which come with specific time bounds and conditions.

Not knowing about these exclusions often causes disappointment at the time of a medical emergency. Therefore, it is always advisable to thoroughly read your policy documents to understand what is not included in your health insurance plan.

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.

Health Insurance Common Exclusions: FAQs

1. What are exclusions in health insurance?

Exclusions in health insurance basically refer to a certain set of medical conditions that are not covered under the health insurance policy, Exclusions are classified as common exclusions and permanent exclusions.

2. What are the common exclusions in health insurance?

The common health insurance exclusions are mentioned below

  • Pre-existing diseases
  • Maternity Related Expenses
  • Mental illness
  • Cosmetic Procedures
  • HIV/AIDS
  • Mental Illness
  • Dental Treatment
  • OPD
  • Obesity treatments
  • Hazardous sports activities
  • Substance Abuse

3. What is the difference between sub-limits and exclusions in health insurance?

Sub-limits are a specific amount set by the health insurance policy that will be spent for a particular coverage and exclusions are things that are not covered under the health insurance or are covered after a specific amount of waiting period.

4. Do health insurance companies provide any riders for permanent exclusions?

No, there are no riders for permanent exclusions.

5. What if I need coverage for any permanent exclusions?

No, insurance companies do not provide coverage for any permanent exclusions.

6. Why do insurance companies have permanent exclusions in health insurance?

To prevent fraud and unnecessary expenses and intentional claims the company has introduced a list of permanent exclusions.

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Naval Goel

Reviewed By: Naval Goel

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.