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Things Health Insurance Does Not Cover

October 10, 2017

A person takes health insurance coverage so that the insurer can take care of the hospital bills, should they ever need a medical treatment in their life. However, there are certain items that are non-payable by them, which is why the individual has to pay for these from their own pocket.



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Exclusions in the Insurance Policy

Irdai (Insurance Regulatory and Development Authority of India) has listed the expenses that insurance providers don’t have to cover in their policies. However, they are free to include any number of them if they want.
There are about 200 assorted items that are not payable by an insurer. However, there are mainly two types of health insurance exclusions, which are:

  1. Permanent Exclusions
    These are the certain illnesses/treatments that are never covered by the insurance policies. Examples include- AIDS, cosmetic surgeries, abortions, and alternative therapies such as reflexology, aromatherapy, naturopathy, etc.
    There are certain illnesses (usually critical or high-cost illnesses like spinal disorders, tumors, cataracts, piles, etc.) for which insurers implement the concept of period “waiting period”. These illnesses are only covered by them once this waiting period is over, which is usually 2-4 years.
  2. Pre-Existing Illnesses
    Pre-existing illnesses are the illnesses that a person has at the time they buy insurance. In most cases, the insurer requires them to wait for a few years before they become eligible for availing treatments for these illnesses. This is to prevent a situation in which an individual gets insurance cover only to immediately benefit from the high-cost treatments.

Note: In case of a senior citizen, an insurer is unlikely to provide coverage for the pre-existing illnesses because of the high possibility of the person to become hospitalized for a long period.

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