Health insurance exclusions you need to know


21 Jul 2023

Read about 4 Health Insurance Exclusions. For more information, check out the health insurance policy from Kotak General Insurance.

Health insurance plans are vital for each one of us as they protect us during medical emergencies without imposing financial burdens. When you opt for a health insurance policy, your insurance provider provides coverage and bears your hospitalisations and treatment expenses on your behalf. While they cover every common disease, there are, however, certain exclusions as well. A few critical illnesses are not included at all, such as HIV and injuries caused by wars or nuclear attacks, whilst a few are included after a specific waiting period.

People frequently avoid reading the terms and conditions of their policies before investing in them. Later, in their time of need, they find out that the disease they are suffering from is not covered. Having a health insurance policy that doesn’t cover you when you need it is nothing but a waste of money. That is why it is significant that you read the policy document carefully and be aware of the inclusions and exclusions of the health insurance you are opting for.

1. Obesity

Even though we are all familiar with this condition, we often tend to ignore it. It is one of the most common lifestyle problems and can occur due to unhealthy eating habits, less exercise, and a hectic lifestyle. Obesity further leads to breathing problems, high blood pressure, cardiovascular disorders, and diabetes, and increases the risk of attracting other lifestyle diseases. Try including the following in your routine:

Given below is a list of a few standard exclusions under health insurance policies. Please note that these exclusions may vary from policy to policy:

1. Expense beyond coverages:

Health insurance/ cashless claim does not mean that 100% of your medical expenses are covered. There is a predetermined cap, called a sub-limit, that is applied to the hospitalisation expenses, such as hospital room rent, doctor/physician consultation charges, ambulance charges, and other medical-related bills. Please note that any expense beyond the sum insured/ sub-limit is excluded and has to be paid out of your pocket.

2. Diseases related to lifestyle:

Typically, diseases caused by unhealthy lifestyles, such as lung disease, liver cirrhosis, or any other conditions because of smoking, drinking, or drug abuse, are excluded from health insurance plans. However, some insurance companies do provide coverage to people who smoke or drink but at high premium costs.

3. Dental treatment, hearing, and vision:

Health insurance cover excludes treatment required for teeth, eyes and ears where no hospitalisation is needed. You may, however, opt for additional riders to get such treatment covered. Surgeries are also a part of this exclusion. Only when surgery is required after an accident, it will be covered by the insurance company.

4. Maternity expenses:

Usually, health insurance plans do not include maternity expenses like checkups, abortions, childbirth, c-section surgeries, fecundity treatments, and so forth. Although a few health insurance companies offer riders or in-built coverage for maternity and childbirth, following a specific waiting period.

5. Diseases caused by suicide or self-harm:

Any injuries that are caused by a suicidal attempt or are self-inflicted (someone who has intentionally harmed themselves) are strictly excluded from the health insurance plans.

6. Cosmetic surgery:

Any cosmetic surgery that has been done to enhance your appearance or looks is excluded from the health insurance policy. However, in the case of an accident, if cosmetic surgery is medically necessary, then it will be covered by the insurance company.


Being vigilant about the exclusions of health insurance plans helps you to choose the best policy and enjoy the maximum benefits. It also prepares you to be ready for crisis time. You can also check if certain exclusions can be covered with add-ons or riders or with a comprehensive health insurance plan.

Team Kotak GIC

The content of this blog has been created and carefully reviewed by the esteemed team at Kotak General Insurance, with the sole purpose of providing valuable guidance and sharing insights on the importance of general insurance. Our objective is to assist users in making informed decisions when purchasing or renewing insurance policies for their cars, bikes, and health. Our expertly curated information aims to empower our readers with the knowledge they need to protect their valuable assets and financial interests.