Concepts about Health Insurance Policy that you must be aware of
There are various factors about health insurance policy that agents usually refrain from discussing at the time of signing a policy. You are made to learn about those only when you file for a claim, and then you receive a financial jolt for which you were just not ready. This article tries to make you aware of some important clauses in your health insurance policy such as Exclusions
and Waiting Period
so that you may avoid facing such a situation. Health insurance exclusions
There are various exclusions in health insurance policy, which means, your health insurance company will not pay for the diseases/medical problems listed under the health insurance exclusion section. In case, the Policyholder
is affected by any such condition listed under exclusion, he will have to bear the expenses on his own.
It is important to know about policy exclusion so that you do not face any financial shock and are ready to bear its cost, in case you have to undergo a treatment listed under policy exclusion.
Though the list of health insurance exclusions varies in different companies, mentioned below are some common treatments for which most companies do not provide any health insurance coverage.
- Pre-existing diseases: This means that you may not get any health insurance Coverage for diseases which pre-existed and has been detected before the commencement of the policy.. However, some companies do provide cover Pre-existing diseases after 2 to 4 years of the policy, if your policy has been continuous.
- Specific ailments : Your health insurance company may not cover treatment for certain medical conditions in the first year of the policy. Expenses related to suicide attempt, self inflicted injury or illness, mental disorder, use of alcohol or drugs are also not covered.
- Dental, vision and hearing treatment : Expenses related to spectacles, contact lenses, hearing AIDS are not covered. Besides, most companies do not provide cover for dental treatments as they generally don’t require hospitalization.
- Pregnancy: Treatment related to pregnancy, child-birth, abortion are typically not covered by most companies.
- Cosmetic surgery: Such treatments are not performed for life threatening conditions and are mostly conducted for aesthetic reasons, and hence are mentioned under health insurance exclusions.
- Resulting from War: Hospitalization resulting due to war like operation, terrorism and nuclear weapon are not covered.
- Alternative therapies: Most companies do not cover expenses related to alternative therapies including acupressure, acupuncture, aromatherapy, massage, reflexology, naturopathy, yoga or obesity related treatment.
- Diagnostic charges: Diagnostic tests which do not concluded the existence of any diseases for which hospitalization is needed are not covered.
Waiting Period in Health Insurance
- Additional charges: Various types of charged levied by hospitals such as admission fees, service charge, surcharge are not payable
Waiting period, also known as the cooling period, determines from when you can are entitled to policy benefits and how long do you need to wait to get cover for the treatment of certain condition. The purpose of the waiting period in health insurance is to dissuade people from only signing a policy when they are aware of their impending medical expenses.
Though the waiting period differs in different companies there are three main types of waiting period that you should be aware of:
- Initial waiting period: It refers to the period from the time of policy initiation under which no expenses will be covered unless there is a medical emergency. Initial waiting period is usually of 30-90 days as per the terms of the policy.
- Ailment-specific waiting period: You are not entitled to receive Reimbursement of treatments related to certain ailments, until the specified waiting period has passed. For instance treatment for hernia or stone is covered after the waiting period of 1 year.
- Pre-existing disease specific waiting period: Treatment for per-existing diseases are not covered until the policy has remained effective continuously for a specified number of years, in most cases two to four years depending on the type of disease.