Medical conditions that are generally not covered under a health insurance plan

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25 May 2023

Excluded Medical Conditions: Understanding Health Insurance Plan Limitations and Coverage Exclusions

Owing to the rising medical awareness and expenses, health insurance is a must for everyone. Before you purchase a plan, you must understand what coverage you will enjoy as an insured/policyholder. However, understanding the exclusions is quintessential. Exclusions refer to the medical conditions that are not covered in your health insurance policy. This means, for such ailments, situations, or medical conditions, your health insurance provider will not provide you with financial aid. Even comprehensive health plans have several exclusions. So, in order to make an informed decision, you must be aware of all the terms of the policy, including the ones not covered. 

Medical conditions generally not covered under a health insurance policy:

In most cases, one medical insurance policy cannot cover all medical conditions. Listed below are the most common exclusions of a health insurance policy:

1. Pre-existing diseases

Any and all the health conditions that you have at the time of purchasing a health insurance policy are considered pre-existing diseases. While some health insurance may not cover pre-existing ailments, others may cover them at an extra premium. Whatever it is, you must inform your insurer about the same. There may be a certain waiting period of a few months or years for pre-existing diseases, and only after serving the waiting period can you raise a claim for the same. 

2. Self-inflicted injuries

Any physical injury that you inflict on your own is considered self-harm. Such medical conditions are out of health insurance coverage. Actions like a suicide attempt, intentional harm to oneself, etc., are excluded from health insurance. 

3. Drug abuse/ overuse of intoxicant

Overdose of drugs can cause severe health complications and even life-threatening conditions. Medical conditions arising due to intoxication remain excluded from a health insurance policy. Some health insurance may also charge extra premiums for those with a regular smoking/ drinking habit. 

4. Cosmetic surgeries

Cosmetic surgeries like botox, augmentation, etc., are generally not life-saving medical treatments. Hence, these are not included in most health insurance policies. In case of cosmetic surgery is needed after an accidental injury, it may be covered. 

5. Pregnancy/childbirth/voluntary abortion

Several health insurance policies do not include pregnancy and childbirth in their health insurance coverage. This is because pregnancy processes can be quite complicated and expensive in many cases. Also, if someone carries voluntary abortion without a doctor's recommendation, expenses of the same are not covered. However, if you are planning childbirth, it is suggested to go for a health insurance policy that covers childbirth and maternity care. 

6. Infertility treatments

Medical insurance is mostly aimed at providing financial aid for unexpected and inevitable medical conditions. Since In Vitro Fertilisation (IVF) and Infertility treatments are planned treatments and not life-saving or inevitable treatments, most health insurance does not cover its expenses. 

Conclusion

These inclusions indicated the most common exclusions, which are generally not covered under health insurance. However, the health insurance coverage largely depends on the type of coverage you have opted for, the insurer, the sum insured, and the add-ons that you have chosen. Some health insurance plans also provide additional coverage to the usually not-covered items in your health plan as well. So, make sure to go through the policy document and read the terms and conditions carefully before making a choice.


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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.