As our lifestyles continue to change, health issues are becoming increasingly complex and prevalent. That’s why having a good health insurance plan is essential. A mediclaim policy provides financial protection during medical emergencies by covering our medical bills and hospitalisation costs. It’s an agreement between you and your insurance company, where the company pays for your healthcare expenses.
However, it’s important to purchase the best health insurance plan in a smart and objective manner. If you don’t, you may be in for an unpleasant surprise in the future. Many people focus on what’s included in their health plan but overlook what’s excluded. This is a critical oversight, as most health policies do not cover certain medical conditions and treatments. These are known as health insurance exclusions, and it’s crucial to understand them to avoid any potential financial setbacks in the future.
While exclusions can vary from person to person, there are certain exclusions that everyone should be aware of when it comes to health policies. Let’s take a look at them.
Exclusions in the Mediclaim Policy
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Pre-existing Medical Conditions
Pre-existing health conditions are not covered during the specified lock-in period. This period usually ranges from 2 to 4 years from the date of purchase. It’s important to declare any pre-existing conditions at the time of purchasing your policy to ensure that they are covered once the lock-in period is over.
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Alternative Therapies
Mediclaim policies do not cover alternative therapies like magnetic therapy, naturopathy, acupressure, etc. Insurance companies face difficulties in determining the exact coverage for these therapies, as they are often unregulated and have varying costs across different specialities like Ayurveda, Naturopathy, and Unani.
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Lifestyle Conditions
Health insurance policies typically exclude coverage for diseases related to the policyholder’s lifestyle unless the policyholder has paid a higher premium. Examples of such diseases include lung disease caused by smoking or cirrhosis caused by alcohol consumption.
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Cosmetic Procedures
As the popularity of cosmetic treatments grows, it is important to note that insurance policies typically do not cover such procedures. While medically necessary plastic surgery to treat an accident or injury may be covered, purely cosmetic treatments are excluded. Similarly, dental treatments are often not covered under a health plan, as they are typically considered to be cosmetic in nature.
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Pregnancy and Related Procedures
Many health plans have exclusions for expenses related to pregnancy and childbirth. This includes the costs of prenatal care, delivery, and postnatal care. Also, treatments related to infertility and abortions are typically not covered by insurance policies.
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Diagnostic Tests
Routine imaging or laboratory tests that are performed for diagnosis can be costly, but they are generally not covered under health policies. However, if the test results indicate that hospitalisation is necessary for an illness or injury, the insurance provider will cover the costs.
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Dental, Hearing & Vision
When it comes to dental and vision procedures, they are usually not covered by health policies because they don’t require hospitalisation. However, if you require hospitalisation for such procedures, it may be covered. It’s always a good idea to check with your health insurance provider to see what is covered and what is not. If you want coverage for dental and vision procedures, you can often purchase additional riders to your health plan.
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Injuries Due to Suicide Attempts
If an individual harms themselves intentionally or attempts suicide, their health insurance policy will not provide coverage for the resulting injuries.
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Waiting Period Clause
When buying an insurance policy, it’s essential to keep in mind the waiting period that each insurance company has before one can use all the benefits of the policy. These waiting periods can vary based on different health conditions.
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Permanent Exclusions
It’s essential to carefully review the fine print of a health plan before signing up, as injuries resulting from war, HIV, intentional harm, and congenital diseases are permanently excluded from coverage. By doing so, you can learn about exclusions and seek clarification from your insurance provider if necessary.
Wrapping Up
To avoid unexpected expenses that are not covered under a mediclaim policy, it is crucial for individuals to carefully review the policy document and fully comprehend the inclusions, e
xclusions, and limitations before selecting the policy. Consult Niva Bupa insurers to know more.
