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What are the exclusions in health insurance?

The increasing cost of medical care has made health insurance a necessity in today’s day and age. Medical insurance is usually bought in order to get protection from any kind of medical emergency, so as to reduce the sudden financial strain posed by a healthcare emergency. However, there are some exclusion in all medical insurance policies offered by insurance companies. In this article, we look at the major exclusions in health and medical insurance policies:

1) Pre-existing illness: The main exclusions right away in any health insurance policy are the pre-existing diseases of the buyer. The buyer is supposed to declare all the diseases and conditions he or she is having and being cured for. The insurance companies impose a waiting period during which the buyer will not get any protection for these diseases. After the waiting period, these diseases will be included in the coverage of health insurance. Some insurance companies have started providing protection for these diseases from day one under the co-pay condition where the buyer has to pay a fixed percentage of the expenses.


2) Adventure sports: Many people nowadays are interested in adventure sports like rock climbing, river rafting etc. The chances of an accident or a mishap resulting in a medical emergency increase and are due to the individual’s voluntary choices. Such expenses are not covered by the medical insurance policies. The buyer will be supposed to bear those expenses from his or her own pocket. 3) Cosmetic surgery: Medical insurance policies do not cover any surgery or any such aesthetic treatment unless deemed necessary for treatment or reconstruction following cancer, accident or burns. The cosmetic surgery done in order to enhance the appearance is not included.

4) Obesity: Any expenses endured towards liposuction or any such weight loss programs are not covered in the medical insurance policies. The buyer will have to bear them out of his own pocket. 5) Psychiatric treatment: The medical insurance policies do not cover any expenses incurred towards psychiatric treatment for any mental disorders. 6) Neurodevelopmental disorders: The health insurance policies do not cover expenses incurred for treatment of neurodegenerative disorders like dementia, Parkinson and Alzhiemer’s disease. Other exclusions include stammering, dyslexia, ADHD (Attention Deficit Hyperactivity Disorder). 7) Birth control and Reproductive treatment: The expenses incurred for treatment related to birth control and other similar procedures and complications arising out of it are excluded. In Vitro Fertilization (IVF) and Gestational Surrogacy are also excluded.


8) Alcohol & drug abuse: The medical insurance policies do not cover the expenses incurred for treatment of alcohol or drug abuse and any disease or complication arising out of it. It also excludes cessation programs of substances like nicotine, alcohol, drugs or any other addictive substances. So, as we saw in this article, there are many medical conditions and situations excluded from the coverage of medical insurance. We hope this article was helpful to you and informed you about the exclusions in a health insurance policy. Have a great day!

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What are the exclusions in health insurance?  

Health insurance can be a daunting task to buy, right? DHFL offers the best health insurance plans in India for family, individual and senio...

What are the exclusions in health insurance?  

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