Health Insurance Plans

pays for your hospital bills for diagnostics, surgery etc.

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Be Aware of the Facts Not Covered in Health Insurance

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It is a common tendency among individuals to assume that once they have bought a health insurance policy, all their medical expenses will be borne by the insurance company. But this is not the case always. Most health care policies, including family floater policies have exclusions. These Exclusions specify the situations under which the medical expenses may not be covered under health insurance.

Here is a broad list of exclusions that most Health Insurance policies specify in their Policy document.

The insurance company will not pay for expenses in connection with complication arising from Pre-existing diseases for a pre-specified duration after issuance of the policy. A pre-existing condition means an injury or disease that the individual may be suffering from prior to the effective date of purchase of the first insurance policy. It is not necessary that an individual be aware of or diagnosed for the pre-existing condition at the time of issuance of the policy.

Until one month after the commencement of policy term, the insurance company will disallow all medical expenses except those related to an emergency situation like accident.

For the first year, expenses on treatment of diseases like fistula, pilonidal sinus, hernia, cataract, BPH (Benign Prostate Hypertrophy), Hysterectomy, Fibromyoma, Hydrocele, Congenital internal disease or sinusitis are not covered under the health insurance plan.

Health insurance also does not cover expenses related to vitamins or supplements if they are not part of treatment of a covered disease in the plan.

Any injury or disease caused by a nuclear disaster or weapon is excluded in a health insurance plan.

Treatment of any complication arising due to pregnancy or child birth is a standard exclusion in most health insurance plans.

Medical procedures like circumcision or plastic surgery is not covered unless it is being done for the treatment of a condition that is not excluded by the health insurance policy.

Reimbursement of spectacles, contact lens, and dental treatment is excluded from Coverage unless it is part of a medical procedure requiring hospitalization.

Treatment of congenital diseases or defects, venereal disease and self inflicted disease (alcohol or drug abuse) are excluded from coverage.

Expenses on routine diagnostic tests are not covered unless they prove the existence of a disease that is covered under the policy.

Treatment of AIDS and conditions related to HIV are also excluded in most policies.

Awareness about these standard exclusions is very important as it can avoid disputes that individuals enter into with health insurance companies. These exclusions are intended to genuinely protect the rightful interest of the health insurance company.