A health insurance plan protects you from the financial impact of various medical costs. Medical expenses related to those generated by minor ailments and injuries, as well as those prompted by severe diseases, are covered by healthcare plans. Unsurprisingly, your health insurance plan only pays for some medical costs. And each cashless health insurance plan has a list of what it covers and doesn’t cover. Exclusions, however, can be a shock if you don’t know about them ahead of time.
The term “exclusion” in health insurance parlance can refer to a medical condition or a healthcare cost that your healthcare plan does not cover. Since it’s not covered, your health insurance company won’t pay for it, and you will have to foot the bill yourself. If you buy insurance wisely and take the time to go through the “Inclusions and Exclusions” and “Terms and Conditions” of a policy before signing n the dotted line or purchasing it online, you can avoid unpleasant surprises in the future.
Exclusions in a healthcare plan that you should be aware of:
- Pre-existing health issues
If you have any pre-existing health problems, you should tell the insurance company about them when you buy a policy. All pre-existing conditions have a waiting period from 2 to 4 years from the date of purchase of the policy.
- Alternative therapies
Most insurance firms do not reimburse for alternative therapies to treat health problems. This is because it’s hard to determine the exact coverage for these therapies since many of them need to be regulated. Also, costs differ for different types of alternative therapies. For example, health insurance does not cover magnetic therapy, acupressure, naturopathy, and other treatments.
- Lifestyle diseases
Healthcare plans don’t cover lifestyle-related diseases unless one pays a higher premium. For instance, diseases not covered by healthcare plans include lung diseases caused by smoking and cirrhosis due to drinking too much alcohol.
- Cosmetic treatments
A healthcare plan does not cover treatments to enhance a person’s looks, like dental care, as it is a cosmetic procedure. However, insurers provide coverage for procedures like plastic surgery recommended by a doctor to treat an injury or accident.
- Pregnancy and having a baby
Numerous healthcare plans don’t cover costs related to giving birth, being pregnant, treating infertility or having an abortion.
- Diagnostic dental, hearing, and vision
Your health insurance plan will not cover treatments related to dental, vision, and hearing procedures unless you require hospitalisation to undergo such procedures. You can, however, add these benefits to your health insurance policy as “riders.”
- Injuries inflicted due to suicide attempt
Your health insurance plan won’t cover any injuries you sustain from hurting yourself or due to a suicidal attempt.
- Waiting period
Each insurance company has a standard waiting period before you can use all of the policy’s benefits. Different healthcare plans on the market have various waiting periods that range from:
- 2-4 years for pre-existing diseases
- 1-2 years for osteoporosis, hernia, and problems related to the ears, nose, and throat
- 90 days for newborn babies and young children
- 2 years for medical issues like spinal problems, joint replacements, internal tumours, cysts, polyps, cataracts, tonsils, etc.
- Permanent exclusions
These include injuries caused by war, HIV, injuries done on purpose, and congenital disorders.
Health insurance policies and the Cumulative Bonus protect you financially if you have to pay a sizeable medical bill. You can always get the best deals while looking for health insurance online and find one that best suits your budget and needs. It would be best to opt for a cashless health insurance plan wherein the network hospital enters into a deal with a health insurance company so that the insured can get medical care without paying out of pocket. But remember to read the fine print before you purchase a policy. You should ask your insurance provider specifically about the things not covered in the policy so that you don’t have to deal with rude shocks when the need arises to make a claim. It is essential to make an informed choice and know the inclusions and, most importantly, the exclusions of your healthcare plan so that you know exactly what’s covered and what’s not.