While buying a health insurance policy brings with it a lot of relief as far as health expenses are concerned, there may also be times of trouble, in case you are not aware about the ailments that are covered and those that aren’t, by your health insurance policy.
It is important to know the exclusions in your health insurance policy, because it may be that sometimes after a hospital stay you could actually get a bill for an item that was already paid for by your insurance and you didn’t even know it. Or even worse, you may have got your dear one admitted and treated in an expensive hospital, only to know that your health insurance policy did not even cover the treatment for the particular illness your dear one suffered from and you ended up paying the cost from your pocket!
Though there are certain insurance exclusions that may be covered by some companies and not by others, here is the list of such common treatments which are not payable under most health insurance policies-
The Health Insurance company shall not make any payment as per the policy in respect of any expenses incurred by the Insured person for the treatment of:
A pre-existing disease is a medical condition that you may have had (whether you were aware of it or not) at any time prior to the commencement of the policy with the insurance company and this definition also includes any complications arising in the future from such a pre-existing disease. health Insurance companies do not pay for pre-existing diseases. However, many companies do have specific waiting periods after which pre-existing diseases do get covered provided the policy renewals have been continuous and without any break.
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The expenses on the treatment of diseases such as Cataract, Benign Prostatic Hyperthrophy, Hysterectomy for Menorrhagia or Fibromyoma, Hernia, Hydrocele, Congenital Internal Disease, Fistula in anus, Piles, Sinusitis and related disorders, Gall Bladder Stone removal, Gout and Rheumatism, Calculus diseases, Joint replacement due to Degenerative Condition and age related Osteoarthritis and Osteoporosis are generally not payable until a specific period of time, which differs from company to company. The specific diseases may also differ with the company.
Resulting from War
Treatment for Injuries or diseases directly or indirectly arising from invasion of a foreign enemy, or due to war like operations, will not be payable by the health insurance company.
Dental Care, Hearing and Vision care
For the most part these are not covered as these do not require hospitalization, and in India, health insurance is mainly associated with the charges for treatment in a hospital. So unless, hospitalization is required, these are not payable.
Cosmetic surgery does not affect the life of an individual. It’s main role and benefit lies only in external looks and beauty, which are not life threatening. Hence, cosmetic surgery of any kind, including botox, liposuction, et al are not payable by the health insurance company. And it is of note, thatcircumcision is now considered cosmetic surgery under most health insurance care plans and is not covered. Circumcision, plastic surgery will be payable only if it forms a part of the treatment of an illness.
As there is still a debate going on, as to whether to legalize abortion or not and if it should be payable, abortion is excluded from reimbursement, until a consensus is reached and a law is made legalizing abortion in India.
These include acupressure, acupuncture, yoga, massage, aromatherapy, reflexology, naturopathy and all those therapies that do not form a part of conventional medicine. These are not covered under health insurance care.
Charges incurred at a hospital or at a nursing home primarily for diagnosis - including x-rays or laboratory examinations - which does not lead to the conclusion of the existence or presence of any ailment, sickness or injury, for which confinement is required at a hospital or a nursing home, will not be payable.
Treatment for pregnancy
Any treatment arising from or traceable to pregnancy including Caesarean section, is not payable under your health insurance policy.
The additional charges
Any kind of service charge, surcharge, admission fees or registration charges levied by the hospital is not reimbursed under your health insurance policy.
Expenses on vitamins and tonics that do not form a part of treatment for injury or disease, will not be paid by the health insurance company. But if these supplements do forma apart of the treatment for a specific illness for which the person has been admitted into the hospital, and if it is certified by the attending physician, then it will be payable.
It is important that you read your health insurance policy carefully, especially the small wordings that may be disguising the exclusions. It is important to always keep a note of those ailments that are not covered under your health insurance policy, handy. This way you will, be in a better position to make an informed choice as far as your healthcare needs are concerned.
Remember not everything is excluded and it’s the job of the policyholder to find out what is excluded and what isn’t.