A Health Insurance Policy's Exclusions

What does a health insurance policy not cover, or what does it not cover?

When a claim is filed, an insurance policy's moment of truth occurs. When an insurance company claims that a certain ailment is not covered by the policy and is an "exclusion," this is one of the most prevalent reasons for a health insurance claim not being paid. It puts a sour taste in the policyholder's mouth and can occasionally put the policyholder in serious financial trouble.

As a result, it is critical to understand the exclusions in health insurance coverage before acquiring it. It is, in our opinion, a considerably more crucial factor than price. Insurance maybe 10% less expensive than a competitor's policy, but it may contain many more exclusion clauses; in this situation, the policy with the fewer exclusion clauses would be the preferable option for the policyholder.

We'll go over some of the most typical exclusion provisions in a health insurance policy in this article. Recently, we've seen some innovation in this area, with new companies not rejecting some conditions that were previously considered exclusive.

1. Maternity: Most individual or family floater health insurance policies do not cover maternity and maternity-related expenses. A group policy will usually cover maternity leave. In other circumstances, maternity coverage is provided after the policy has been in place for five years.

2. Infections or diseases contracted within the first 30 days of coverage. This is done by the insurance company to protect itself from customers who acquire coverage right after an illness is discovered.

3. Cataract, prostrate, hernia, piles, fistula, gout, rheumatism, kidney stones, tonsils, and sinus related disorders, congenital disorders, drug addictions, non-allopathic/alternative treatments, self-inflicted injuries, hysterectomy, fertility-related treatments, and other conditions are typically not covered by health insurance policies. Cosmetic surgery and dental therapy are usually not allowed. The cost of contact lenses is also not covered. HIV/AIDS is not included, which has been the topic of much discussion and criticism in recent weeks. Some insurance companies will not cover treatment received outside of the nation, so double-check before purchasing coverage.

4. health insurance coverage does not cover pre-existing conditions. A preexisting condition is one that you had before enrolling in a health insurance plan. The pre-existing disease may or may not have been known to the policyholder. Complications that emerge as a result of the pre-existing condition are also not covered. Renal problems that emerge as a result of a person having diabetes at the commencement of the coverage, for example, would not be covered. This can cause a lot of uncertainty as well as heartburn.

5. While most policies do not cover daycare, a few, such as Max Bupa, do, though the premium is higher.