Categorized | Health Insurance

facts about exclusions in health insurance

Introduction
You may take your dear one with a serious ailment to one of the top hospitals in town to get the best treatment. You are also under the impression and assurance that though the medical bills will be high, your Mediclaim Policy will take care of the expenses. However, to your dismay and shock, you discover that your medical bill will not be covered by your Health Insurance policy and you will have to pay from your own pocket.
 
To avoid these kinds of situations, you must be well aware of the various aspects of a medical insurance policy when you get one. You must be sure of what are your requirements, what a medical insurance policy covers, total amount of health Coverage required for you and your family, the network of hospitals, and most important of all- the Exclusions in the policy. To be specific, exclusions define the diseases and infirmities that will not be covered by the insurance policy.

It is important to know the details of the exclusions to avoid being caught unawares during Hospitalization or an emergency. Exclusions may be only for the first year or may be permanent. For example, cosmetic surgery and most dental issues are never covered by medical insurance; cataract is typically excluded from coverage during the first year of the policy, but covered later. There may also be exclusions that are covered by some insurance companies but not by others.

You must therefore know in detail about what is and what is not covered by your medical insurance policy. This is for your own and your family’s benefit so that you will be financially secure during a medical emergency. There are some common issues that are generally not covered by most medical insurance policies.

Situations typically not covered by most medical insurance policies are:
Illness or injury that happens in the first month of the policy coverage.

Pr-existing illnesses at the time the policy is taken:
Any medical condition that you had before you took the mediclaim policy, or any complications arising from it in future, are generally not covered by mediclaim policies. However, some companies do cover these illnesses after a Waiting Period if your health insurance renewals have been continuous, without breaks.

Diagnostic and Registration charges:
Charges incurred for admission fees and registration in hospitals, general x-rays, laboratory examinations, etc. conducted for illnesses that don’t require hospitalization are typically not covered by medical insurance. Also, cost of vitamins and tonics is payable by insurance only if prescribed by doctor during hospitalization.

Dental Care, Vision and Hearing Related Medical Expenses:
Unless hospitalization is involved, these are generally not covered by health insurance.

War Injuries:
War-related illnesses and injuries are generally not covered by health insurance policies.

Cosmetic Treatment:
Cost of cosmetic treatment, surgeries etc. are not covered by mediclaim.

Certain Ailments:
Ailments like Fibromyalgia, Piles, Fistula, Sinusitis, Gall Bladder stone; Gout, Rheumatism, Joint replacement; Osteoarthritis and Osteoporosis are generally not payable by medical insurance. The specific diseases may differ from company to company.

Abortion:
Abortion is generally not payable by insurance as it is still considered illegal.

Alternative Treatment:

Alternate treatment methods such as massage, aromatherapy, acupressure, acupuncture, naturopathy etc. are not covered by health insurance policies.

You must therefore read your medical insurance policy carefully and in detail before you get your insurance coverage. You must especially be careful about the fine details about exclusions. You must always know about what is excluded and what is not so that you will get full benefit from your medical insurance policy.