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Six Common Exclusions in Health Insurance Plans

Posted by Royal Sundaram on 14 Jun 2016

If health plans are not purchased in a smart and objective manner, you may be in for a nasty surprise in the future. As is the case with many purchases, we tend to delight in what we are getting out of the purchase, while overlooking what is missing. This is especially true in the context of health care policies. Most people take a detailed look at the inclusions, but often fail to check the exclusions.

Policyholders are often disappointed and distressed when they learn that their expensive dental treatments or cosmetic surgery procedures are not covered in their health plan. It helps to stay informed about common exclusions in policies, so that you can verify the inclusion or exclusion of required features before you make a purchase. Certain common exclusions include:

  1. Pre-existing conditions

If you suffer from any health issues it is important that you declare the same, while purchasing a standardĀ health insurance. All such pre-existing conditions are covered at the end of a specified lock-in period, ranging between 2 and 4 years from the purchase date.

  1. Alternative therapies

Most insurance companies do not provide coverage for the use of alternative therapies to treat health conditions. This is primarily because determining the exact coverage for such therapies is difficult as many alternative treatments are unregulated and the various specialties like Ayurveda, Naturopathy, and Unani have different costs.

  1. Lifestyle related conditions

Diseases that relate to the lifestyle of the insured are excluded under health plans, unless the purchasers have paid a higher premium amount. Some such conditions are lung disease caused due to smoking or cirrhosis resulting from the consumption of alcohol.

  1. Cosmetic treatments

An increasing number of people use cosmetic treatments to enhance their appearance, but these treatments are not covered by health insurance companies. However, medically recommended procedures like plastic surgery to treat an accident or injury will be covered. Dental treatments are also excluded from health plan coverage, as these are considered to be cosmetic in nature.

  1. Pregnancy and childbirth

Several health plans do not provide coverage for childbirth and pregnancy related expenditure. Similarly, costs for treating infertility and abortion are not covered under these insurance policies.

  1. Diagnostic expenses

Imaging or laboratory tests that are routinely conducted for a diagnosis can be quite expensive, but these are not covered under health policies. If the tests yield a positive result for any illness or injury that requires hospitalization however, the insurer will cover the costs.

Individuals should read the policy document carefully to ensure they completely understand the inclusions as well as the exclusions. Reputed insurance companies like Royal Sundaram make such information clear before the purchase, so make it a point to avoid insurers without much market credibility. Royal Sundaramā€™s health policies are also affordable and customizable, suiting the needs of every type of customer.


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