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Every health insurance policy comes with a list of benefits and exclusions. Exclusions, however, are the ones that, if you are unaware of them, can come up as a nasty surprise. For example-policyholders are often distressed when they realise that their expensive dental treatment or cosmetic surgery procedures can’t be covered under their health care plan. Hence, being aware about common exclusions and inclusions can definitely keep you informed in future while you file a claim for any of your health conditions.
We have listed down the 7 Most Common Exclusions Under Your Health Insurance Plan you must read about.
Most Common Health Insurance Exclusions
Even though exclusions vary from one policy provider to another, there are the most common exclusions in health insurance policies that you need to look at beforehand to keep yourself well-informed.
Waiting Period
Almost every health insurance plan comes with three kinds of waiting periods. They are as follows:
- Initial Waiting Period- Any claim arising for expenses that are related to any illness within 30 days of the policy commencement date will be excluded except for claims arising due to an accident.
- Specific Waiting Period- Expenses related to the treatment of the listed conditions, surgeries/treatments come in exclusion until the completion of 24 months after the date of inception of the policy.
- Pre-existing Diseases Waiting Period- The most common waiting period is the Pre-existing waiting period in all the health insurance plans. If you have an illness or a medical condition before the commencement of a health insurance plan, then there will be no coverage under the policy for 2-4 years, depending upon the type of health condition and its risk.
Obesity/Weight Control
Obesity being one of the most common health conditions these days is directly related to lifestyle health condition and health insurance policies usually don’t provide coverage for the same. Thus, it is really important to understand what all is covered under your plan and what is not.
Hazardous/Adventurous Sports
Going out on an adventurous vacation is always exciting but with fun comes the risk of injuries that can potentially burn a hole in your pocket. So, the expenses related to any treatment due to hazardous or adventure sports including but not limited to rock climbing, mountaineering, rafting, motor racing, horse racing etc. will not be covered under your health care plan.
Breach of Law
Often people get involved in a fight or attempt to commit a breach of law with criminal intent and get physically hurt. So, the expenses for treatment directly arising due to breach of law will not be covered by your health care plan.
Refractive Error
Correction of eyesight has become the most common treatment among people these days but people often mistake and expect that their LASIK surgery will be covered under their healthcare plan. It is only covered under all basic health plans if the patient’s refractive error is equal to or more than 7.5 dioptres.
Dental Treatment
The most common exclusion, dental treatment is the same in almost all healthcare plans unless there is injury due to an accident and could be life-threatening as advised by the doctor.
Sterility and Infertility
Any condition like sterility and infertility arising from traceable to pregnancy, are not covered under a health insurance policy. However, pregnancy can be covered in some health insurance plans but only after a waiting period.
In a Nutshell
Being careful of the benefits and exclusions in health insurance will definitely save you from unnecessary hassle while you file your claim. However, every health care plan isn't the same and neither is every insured person, so it is always recommended to check on the fine print of your policy. That’s how you will know beforehand which claim will be honoured by your insurer, and which won’t. Although Care Health Insurance offers a wide range of comprehensive health insurance plans, it is always recommended to go through your policy fine print thoroughly especially the exclusion part to avoid an unpleasant surprise at the time of claim.
Disclaimer: The above-mentioned information is for reference purposes only. Please read your policy documents carefully to know more about the benefits and exclusions.
