ARTICLES

The awareness of health insurance plans is growing among consumers as medical expenses are increasing. Nowadays, most individuals insure themselves and their families in a health insurance policy to get financial security in the face of medical emergencies. 

Modern-day health insurance plans are quite comprehensive when it comes to their coverage benefits. They try to provide the most inclusive coverage so that most of your medical bills get covered. However, there are some instances wherein the claim is not covered by the policy. Have a look at 8 such things that are not covered in most health insurance plans – 

Pre-existing diseases 

Pre-existing diseases or illnesses are medical conditions that you might have when you buy a health insurance policy afresh. For instance, if you are suffering from asthma or diabetes and you are buying a new health insurance policy your medical condition would be considered as a pre-existing disease. Such pre-existing diseases are not covered during the first few years of the policy. This period is called the waiting period and it ranges from 12 months to 48 months across policies.

So, if you or any insured family member suffers from a pre-existing condition, check the waiting period when you are buying the policy. Opt for a policy with a lower waiting period so that your condition gets covered at the earliest.

Pre-existing diseases have a waiting period only if you have such diseases at the time of buying a fresh policy. If you develop any disease after you have bought the policy, the waiting period does not, usually, apply. Moreover, if you port an existing health plan to another plan, you get credit for the waiting period already expired in the last policy.

Cosmetic surgery or treatments

Cosmetic surgeries which are not medically necessary and are undertaken for enhancing your appearance are not included in health insurance plans. However, in the case of any injury or illness, if cosmetic treatment becomes a necessary course of treatment, the cost of such treatments would be covered by the policy.

Health supplements

Health supplements include additional supplements that might be advised by the medical practitioner as a part of your treatment. Vitamin, protein, or other supplements that you buy, however, are not covered by the health insurance policy. Even if such supplements are prescribed by the doctor, you have to pay for their costs.

Abortion or miscarriage

Health plans that cover maternity allows coverage for childbirth and pre and post-natal expenses. However, if you suffer a miscarriage or opt for an abortion, the medical costs incurred would not be covered. 

Diagnostic expenses wherein treatments are not involved

If you are hospitalised for availing of diagnostic treatments and your hospitalisation does not include any form of treatment or surgery, the cost of the diagnostic treatments would not be covered. However, if the diagnostic treatments are followed by medical treatments that you receive as an inpatient, the cost of such diagnostic tests would be covered.

Unorthodox treatments

Unorthodox treatments mean medical treatments that are not usually followed by doctors in treating a particular injury or illness. Such treatments are also called unscientific, unproven, or experimental treatments and such treatments are not covered under health insurance plans.

However, some policies might allow coverage for such unorthodox treatments. You should, thus, check the scope of coverage of your policy to find out whether such treatments are covered or not. Chances, however, are that they would be excluded. 

Discharge against the doctor’s advice

If you take a discharge from the hospital against the doctor’s advice and later suffer medical complications, the costs of treating such complications would not be covered in your health insurance policy. Discharge and post-hospitalisation expenses are covered only if they are prescribed by the attending doctor or medical practitioner. 

Consumables 

Consumables are one-time use medical items like gloves, masks, bandages, syringes, etc. The cost of these consumables is not covered by the health insurance policy. 

Almost all health insurance policies exclude these eight types of claims. The rest of the list of exclusions is policy-specific. So, when you are buying, porting or renewing your health insurance policy, check the exclusion list. Even if you avail of comprehensive coverage, the aforementioned expenses would not be covered by your policy. So, be an informed policyholder so that you don’t make a claim for an excluded expense and avoid claim rejections.