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What does Health Insurance not cover?

A health insurance policy proves to be a blessing in a medical emergency when you or your family members are hospitalised and you incur a huge medical bill. The policy covers the medical costs and provides financial relief to you and your savings. It is, therefore, advised to invest in the best health insurance for your family. 

Though the scope of a health insurance plan is quite inclusive, there are instances when claims are not paid under the policy. These instances are called policy exclusions which are the medical expenses not covered by a health insurance plan. When you buy health insurance online, you should know about these exclusions so that you know what to expect from the policy. So, here are some of the common exclusions which are not covered even when you buy the best health insurance for your family –

  • Claims during the waiting period

Under every health insurance plan, there are different types of waiting period during which specific claims are inadmissible. These waiting periods include the following –

  • Initial waiting period – claims due to illnesses which occur within the first 30-90 days of buying the policy are not covered. This is the initial waiting period during which claims for any type of illnesses are not paid. However, claims for accidental injuries are admissible from the first day of the policy.
  • Specific diseases waiting periods – specific illnesses and/or treatments are not covered during one or two years from the date of commencement of the policy. Common illnesses and treatments which have this waiting period include treatments for piles, hernia, tonsillectomy, joint replacement surgeries, fibroids, etc.
  • Pre-existing waiting period – if you or your family member suffers from an illness when buying health insurance online, such an illness is called a pre-existing illness. Such illnesses are not covered during an initial waiting period ranging from 1 year to 4 years under different plans.
  • Maternity waiting period – if your health insurance plan has an inbuilt coverage for maternity, such coverage is allowed only after a specified waiting period which can range from 9 months to up to 6 years.

Claims during the above-mentioned waiting periods are not admissible but once the waiting period is over, the health insurance plan pays the claims.

  • Specific treatments

There are specific treatments which are completely excluded from the coverage of health insurance plans. These include cosmetic treatments, dental treatments, LASIK treatments for eyesight correction, fertility treatments, weight management treatments, etc. 

  • Other exclusions

Other instances which are commonly excluded from health insurance plans include medical expenses incurred due to the following instances –

  • Self-inflicted injuries or attempted suicide
  • War, nuclear contamination or allied perils
  • Maternity related expenses unless they are specifically covered under the plan
  • Outpatient expenses unless they are specifically covered under the plan
  • HIV, AIDS or other types of venereal diseases
  • Congenital diseases or birth defects
  • Unproven, unscientific or experimental treatments
  • Injuries or accidents suffered due to alcohol and/drug abuse
  • Injuries or accidents suffered when committing an act of criminal nature
  • Injuries or accidents suffered when participating in hazardous activities
  • Debilitating illnesses
  • Cost of lenses, spectacles or hearing aids, etc.

These are some of the common exclusions which you would find in most health insurance plans. However, under some plans, a few of these exclusions can be a part of the coverage benefit. So, when you buy health insurance online, you should read the coverage and exclusion list of your policy to know exactly what is covered and what is not. Then you should compare and select the best health insurance for your family which has a limited exclusion list and a comprehensive range of coverage benefits. Such a plan would provide the most inclusive coverage to your family ensuring that most of your medical costs get covered and your out-of-pocket expenses are minimized.


Published by Nidhi Mehra

I am blogger with 5 years of experience in writing articles and topics related to finance and funds

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