Things That are not covered under Medical Insurance


Diseases That Are Not Covered Under Health Insurance

After spending 3 years of togetherness, Nirja and Rahul, a happily married couple, have decided to enter into parenthood. But, soon, Nirja was diagnosed with a severe infertility problem, and her gynecologist suggested her surgery. Counting on her health insurance policy, she started the treatment from the top infertility centre to avail of the best possible healthcare. However, she was disappointed when she came to know that her claim was rejected by her insurance company. Left with no clue, Rahul and Nirja met the hospitalization expenses from their pocket. This incidence derails their lives and finances. Later, she came to know that infertility treatment comes under the insurance company’s exclusion that’s why she was not entitled to get the reimbursement. So, to avoid such misconceptions read this article till the end to have clarity on what types of diseases not covered under health insurance. But, before that let’s understand what exclusions in health insurance claims are?

Health Insurance Exclusions

Health insurance exclusions are situations and cases that are not covered under the claim policy according to the guidelines given by IRDA. The insurance provider has the full right to reject the claim if it is related to the diseases or treatment that comes under exclusions. So, opt for the cover that offers maximum coverage with minimal exclusions. Read the diseases that are not covered under a health insurance plan:

  • Pre-existing Diseases: Any diagnosis of diseases / undergoing of surgery/occurrence of an event, whose signs or symptoms first occur within 30 days of policy period start date.
  • Self-Inflicted Injury: Expenses attributable to self-inflicted injury such as suicide, attempted suicide, etc.
  • Injuries Due to Consumption of Alcohol: Expenses arising out of or attributable to alcohol or drug use/misuse/abuse.
  • Transmitted Diseases: Medical expenses incurred for the treatment of AIDS and other transmitted diseases.
  • Pregnancy Treatment: Treatment arising from or traceable to pregnancy and childbirth, miscarriage, abortion, and its consequences.
  • Infertility Treatment: Tests and treatment relating to infertility and in vitro fertilization cannot be claimed.
  • Congenital Diseases: Expenses incurred for the congenital disease also do not cover under health insurance. These are the diseases or disabilities occur due to birth defect. 
  • Permanent Exclusions: War, riot, strike, and nuclear weapons induced hospitalization are considered as permanent exclusions.
  • Cosmetic Surgery: Plastic surgery, cosmetic treatment, and implant are also not covered under an insurance policy.

Check: Mediclaim Policy Premium Calculator

Need for Health Insurance Exclusions

Exclusions narrow the scope of insurance coverage. Read below the need of health insurance exclusions:

  • It carves the coverage for risks that insurer not willing to reimburse.
  • Some risks are uninsurable because they can affect several policyholders at one go for example war and natural calamity.
  • Some treatment and hospital expenses are manageable so no need to cover under an insurance claim.

Sum Up!

Health Insurance Policy is the financial support that you get during a medical emergency and cover your healthcare expenses. However, insurance providers have a limited window. It’s difficult for them to cover all sorts of diseases under one cover. Therefore, exclusions give a sense of responsibility to a policyholder not to ask for the claim against petty medical expenses. So, if you are planning to opt for health insurance, prefer the plans offered by Care Health Insurance (Formerly Religare Health Insurance) that has minimal exclusions with maximum coverage. You should go through the exclusions list and see what diseases not covered under health insurance to make the most out of it.