The Buyt Desk
Health Insurance does not cover everything. Always check with your insurance provider about the illness and services that they do not cover. If you feel the need of a certain specific cover that should be part of your insurance then add riders to your policy.
All health insurances are not the same. The coverage is different for different policies provided by various insurance companies. Check with your insurance provider for a list of inclusions and exclusions for your health insurance plan. These lists adhere to the rules of the Insurance Regulatory and Development Authority of India (IRDAI). When you claim the health bills and if the illness or service is not covered then the claim will be rejected. So it is advised that you do proper research about the health policy before you buy it. Check if all the illness and services you need are covered if not check the riders that would cover your needs and add it to your health insurance plan. Go for policies with maximum coverage and minimal exclusions. Do check the waiting period for all illnesses. Some are covered from day one but some have a waiting period of 1 or 2 years.
Few common health insurance exclusions in India are dental surgery/ treatment, venereal disease, use of intoxicating drugs/alcohol, Self-inflicted injuries, naturopathy treatments, the cost of spectacles, contact lenses and hearing aids, diagnosis expenses, congenital external defects, convalescence, general debility, AIDS and infertility treatments. Let us look into details of diseases and treatments that are generally not covered under a health insurance plan.
Cosmetic surgeries
Cosmetic surgeries are excluded from a health insurance policy including Liposuction, Botox, plastic surgery and implant surgeries. But cosmetic surgeries needed as part of treatment post accident are covered under health insurance plans. Check with your insurer if you plan a cosmetic surgery or treatment.
Pre-existing illnesses
Each insurance has different rules for pre-existing diseases and related waiting periods. Some health plans cover pre existing conditions like blood pressure, diabetes and heart ailments. Few cover such conditions only after a waiting period of 1, 2 or 4 years. There are very few health plans that cover pre existing diseases from day one.
Infertility and Pregnancy related conditions
Hospitalization expenses of abortions, maternity and pregnancy are not covered under basic health insurance. Maternity health plans cover these expenses. Some policies covering pregnancy and delivery have a waiting period. Check with your insurer explicitly while buying a policy if you want these to be covered.
Dental Coverage
Dental treatments mostly do not need hospitalization, so are not covered by health insurance plans. But the dental treatment as part of post accident treatment is covered.
Hearing and Vision
If conditions are pre existing, check with the insurer if it is covered. Hearing and vision treatments that do not need hospitalizations are not covered. Only when it is part of post accident treatment, expenses are covered by health insurance.
Health supplements
Health tonics and supplements are not covered by health insurance policy. When it is part of the treatment and prescribed by a doctor, the expenses might be claimable.
Conditions due to overconsumption of Alcohol
Claims of conditions like liver damage caused because of overconsumption of alcohol can be rejected by the insurance company as they hold the right to reject.
Alternative therapies
Few alternative therapies are reflexology, naturopathy, acupuncture, acupressure etc. Expenses incurring in such treatments are not covered by health insurance plans.
Suicide attempt
Health insurance plans do not cover intentional self-injury, including attempt to commit suicide and injury or illness due to drugs or alcohol.
Criminal activities
Health insurance plans do not cover health bills directly or indirectly related to criminal acts including wars and nuclear power damage.
Extra charges during hospitalization
Health insurance plans do not cover registration fees, admission fees and service charges.
Few medical conditions
Health insurance plans do not cover a few specific medical conditions including cataract, calculus diseases, hydrocele, hernia, benign prostatic hypertrophy, joint replacement, sinusitis, piles, gallbladder removal, fistula in anus and osteoporosis. Some insurers cover partial costs or have waiting periods.
Diagnostics Charges
Health insurance plans do not cover diagnostic or pathological services. Scans, blood tests, x-Rays, MRI and other body tests are not covered by the policy.
Summing up
Always check with your insurer the things that are covered. You will know a few things based on your health conditions, family history and family plans, health issues that need to be covered. To keep yourself away from negative experience and financial crunch during health issues, go through the terms and conditions, inclusions and exclusions of your health insurance plan when you buy it. You can buy the riders if you feel you will need some extra cover in the near future.
