List of Common Exclusions Under Health Insurance Policy

Understand health insurance policy exclusions, including pre-existing conditions, elective procedures, cosmetic surgeries, and more. Read on to get more details.
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3 min
30-January 2024

Health insurance is a critical component of financial planning, providing a safety net against the rising costs of medical care. However, policyholders need to be aware of the terms and conditions of their health insurance policy, particularly the exclusions. Exclusions are specific conditions or situations that are not covered by the insurance policy.

Understanding these exclusions is crucial to avoiding unpleasant surprises and ensuring that your health insurance coverage aligns with your healthcare needs. In this article, we will explore why checking exclusions is important and highlight ten common exclusions found in health insurance policies.

Why should you check exclusions before buying health insurance?

Before purchasing health insurance, it is imperative to carefully review the policy document and understand the exclusions. Failing to do so may lead to misunderstandings and financial setbacks when making a claim. Here are some key reasons why checking exclusions is crucial:

  • Clarity on coverage:
    Reviewing exclusions helps you gain clarity on what is covered and what is not under your health insurance policy. This knowledge allows you to make informed decisions about your healthcare and financial planning.
  • Financial preparedness:
    Knowing the exclusions helps you financially prepare for potential expenses that may not be covered by your health insurance. This ensures that you are not caught off guard during a medical emergency or planned medical procedures.
  • Avoiding disputes:
    Understanding exclusions prevents disputes with the insurance company during the claims process. Being aware of the limitations of your policy can help you navigate the claims process smoothly and reduce the chances of claim rejection.
  • Choosing the right policy:
    Different health insurance policies have varying exclusions. By carefully examining the exclusions, you can choose a policy that aligns with your health needs and preferences.
  • Managing expectations:
    Knowing the exclusions sets realistic expectations regarding your health insurance coverage. It prevents assumptions that may lead to disappointment when specific healthcare expenses are not covered.

10 common exclusions of health insurance

  1. Pre-existing conditions:
    Most health insurance policies have exclusions for pre-existing conditions. A pre-existing condition refers to any medical condition that you had before purchasing the policy. You can get an add-on for pre-existing disease cover.

  2. Cosmetic surgery:
    A health insurance policy may not cover cosmetic procedures such as facelifts, rhinoplasties, or liposuction, as they are typically voluntary and not necessary for medical reasons.

  3. Dental care:
    Standard health insurance policies often do not cover dental care, such as fillings, crowns, root canals, and dentures. However, most insurers provide separate dental insurance policies that focus on dental care.

  4. Experimental procedures:
    Health insurance policies usually do not cover experimental procedures such as stem cell therapy, which is still in the trial phase.

  5. Alternative medicine:
    Alternative therapies like acupuncture, homoeopathy, and naturopathy are typically not covered by health insurance policies.

  6. Maternity care:
    Some health insurance policies may not cover maternity care, including prenatal, delivery, and postnatal care.

  7. Weight-loss surgery:
    Most health insurance policies have exclusions for weight loss procedures, such as gastric bypass surgery, which are primarily performed for cosmetic purposes.

  8. Self-inflicted injuries:
    Suicide attempts, self-harm, or intentionally putting oneself in harm's way, such as consuming toxic substances or drugs usually are not covered in a health insurance policy.

  9. Pregnancy and fertility:
    Many health insurance policies exclude infertility treatments, including in-vitro fertilisation, as well as procedures related to pregnancy such as childbirth and abortion.

  10. Medical treatment overseas:
    Health insurance policies may have exclusions for medical care outside the country, even in case of an emergency medical evacuation.

When buying a health insurance policy, it is essential to understand the policy's exclusions to ensure that you are not caught off guard when making a claim. By knowing the common exclusions in health insurance policies, individuals can make informed decisions and choose policies that offer the necessary coverage. Before purchasing a health insurance policy, it's crucial to compare various insurance plans to ensure that you receive the best value for your money. Ultimately, it is essential to read the policy document carefully, understand all the terms and conditions, and ask questions to clarify any doubts.

Disclaimer

Insurance is the subject matter of solicitation. *T&C Apply - Bajaj Finance Limited (‘BFL’) is a registered corporate agent of third party insurance products of Bajaj Allianz Life Insurance Company Limited, HDFC Life Insurance Company Limited, Future Generali Life Insurance Company Limited, Bajaj Allianz General Insurance Company Limited, SBI General Insurance Company Limited, ACKO General Insurance Limited, ICICI Lombard General Insurance Company Limited, HDFC ERGO General Insurance Company Limited, Tata AIG General Insurance Company Limited, Niva Bupa Health Insurance Company Limited , Aditya Birla Health Insurance Company Limited, Manipal Cigna Health Insurance Company Limited and Care Health Insurance Company Limited under the IRDAI composite CA registration number CA0101. Please note that, BFL does not underwrite the risk or act as an insurer. Your purchase of an insurance product is purely on a voluntary basis after your exercise of an independent due diligence on the suitability, viability of any insurance product. Any decision to purchase insurance product is solely at your own risk and responsibility and BFL shall not be liable for any loss or damage that any person may suffer, whether directly or indirectly. Please refer insurer's website for Policy Wordings. For more details on risk factors, terms and conditions and exclusions please read the product sales brochure carefully before concluding a sale. Tax benefits applicable if any, will be as per the prevailing tax laws. Tax laws are subject to change. BFL does NOT provide Tax/Investment advisory services. Please consult your advisors before proceeding to purchase an insurance product. Visitors are hereby informed that their information submitted on the website may also be shared with insurers. BFL is also a distributor of other third party products from Assistance Services providers such as CPP Assistance Services Pvt. Ltd., Bajaj Finserv Health Ltd. etc. All product information such as premium, benefits, exclusions, sum insured, value added services, etc. are authentic and solely based on the information received from the respective insurance company or the respective Assistance service provider company.

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