While buying a health insurance policy brings with it a lot of relief as far as claims expenses are concerned, there may also be times of trouble, in case you are not aware about the aliments that are covered and those that aren’t, by your health insurance policy.
It is important to know the exclusions in your health insurance policy, because it may be that sometimes after a hospital stay you could actually get a bill for an item that was already paid for by your insurance and you didn’t even know it. Or even worse, you may have got your dear one admitted and treated in an expensive hospital, only to know that your health insurance policy did not even cover the treatment for the particular illness your dear one suffered from and you ended up paying the cost from your pocket!
Standard Exclusions under Health Insurance policy
1. All diseases/ injuries which are pre existing when the cover incepts for the first time.
2. Any disease other than those stated in the third exclusion below contracted by the insured person during the first 30 days from the commencement date of the policy. The exclusion does not apply to treatment for accidental injuries.
3. During the first year of the operation of Insurance cover, the expenses on treatment of disease such as
(a) Cataract, Benign Prostate Hypertrophy, Hysterectomy for Menorrhagia or Fibromyoma, Hernia, Hydrocele, Congenital internal disease/defect, Fistula in anus, piles, Sinusitis and related disorders are not payable.
(b) If these diseases (other than congenital internal diseases/defect) are pre existing at the time of proposal they will not be covered even during subsequent period of renewal.
(c) If insured is aware of the existence of congenital internal diseases/defect before inception of policy it will be treated as pre-existing.
4. Injury or disease directly or indirectly caused by or arising from or attributable to War, Invasion, Act of Foreign enemy, war like operations (whether war be declared or not).
5. Circumcision unless for treatment of a disease not excluded hereunder or as may be necessitated due to an accident, vaccination or inoculation or change of life or cosmetic or aesthetic treatment of any description, plastic surgery other than as may be necessitated due to an accident or as a part of any illness.
6. Cost of spectacles and contact lenses, hearing aids.
7. Any dental treatment or surgery which is a corrective, cosmetic or aesthetic procedure, including wear and tear, unless arising from disease or injury and which requires hospitalisation for treatment.
8. Convalescence, general debility, “Run-down” condition or rest cure, congenital external disease or defects or anomalies, sterility, venereal disease, intentional self-injury and use of intoxicating drugs/ alcohol.
9. All expenses arising out of condition directly or indirectly caused to or associated with human T-cell Lymphotropic virus type III (HTLB-III) or Lymphadinopathy associated virus (LAV) or the mutants derivative or variations deficiency syndrome or any syndrome or condition of a similar kind commonly referred to as “AIDS”.
10. Charges incurred at hospital or nursing home primarily for diagnostic, X-Ray or laboratory examinations not consistent with or incidental to the diagnosis and treatment of the positive existence or presence of any ailment, sickness or injury for which confinement is required at a hospital/ nursing home.
11. Expenses on vitamins or tonics unless forming part of treatment for injury or disease as certified by the attending physician.
12. Injury or disease directly or indirectly caused by or contributed to by nuclear weapons or materials
13. Treatment arising from or traceable to pregnancy, childbirth, miscarriage, abortion or complications of any of this, including caesarian section.
14. Naturopathy treatment.
Please note, the above are Standard exclusions only. Please check with your Health Insurance provider’s policy wording for exact exclusions to your Health Insurance Policy.