What are the things that a Health Insurance policy not cover?

Mar 05, 2018 | 2 years ago | Read Time: 2 minutes | By iKnowledge Team

Tobacco users and individuals affected by HIV-AIDS, late-stage cancer and genetic illnesses are not covered.

Deepak was in his mid-thirties and was healthy for his age until one day he was rushed to a hospital for a breathing problem. When he approached his health insurance company to pay for his treatment, he found that his claim was turned down as he was a tobacco user and hadn’t disclosed this earlier.

Deepak learnt it the hard way that smokers are not covered for any tobacco-related illnesses. In fact, even those who have quit smoking cannot make a claim for any tobacco-related problem.

If you’re wondering what else isn’t covered under a health insurance plan, here’s a list:

Cancer treatment

Health insurance plans do provide cover for cancer. However, they do not pay for the entire medical treatment in India. Therefore, you need to opt for a specialized cancer insurance policy.

Genetic illnesses

If you suffer from a genetic illness or congenital disease, your insurer may not cover you. Health insurances do not include genetic disorders like hemophilia, sickle-cell disease, thalassemia, cystic fibrosis or Down’s syndrome etc. They are regarded as high-risk pre-existing illnesses.

Fertility treatment

Fertility treatments like in-vitro fertilization and expensive fertility procedures are also excluded from health covers.

HIV/AIDS-related treatment

People with HIV/AIDS are not covered by health insurance companies. Since their immunity system gets depleted, they are prone to falling ill, which makes them a high-risk group for insurers.

Alternative treatments

You cannot claim for health insurance benefits if you are opting for alternative treatments like Ayurveda, naturopathy, acupuncture or any wellness treatments. However, there are some insurance companies which may cover alternative treatment under certain terms and conditions.

Cosmetic surgery for aesthetic enhancement

Those seeking reconstructive surgery for accidents and require hospitalization are covered by health insurance policies. However, if you are planning to undergo surgery for aesthetic reasons, you will have to pay from your pocket.

Dental, optical and hearing treatment

Some insurers cover dental treatment only if it arises out of an accident and requires hospitalization. Most policies don’t cover you for dental, optical or hearing-related treatment.     

War, nuclear risks, self-inflicted injury

Insurance companies don’t pay for treatment arising from war, terrorism, civil unrest, suicide attempts etc.

Weight-loss treatments

Although you may be advised to lose weight for health reasons, health insurance companies do not pay for weight loss treatments.

However, some insurers may cover gastric bands, laparoscopic gastric bypass and gastric sleeve surgery as they require hospitalization.

Overseas treatment

If you are planning to go overseas for a medical treatment, you will have to bear the costs personally.

Hospitalization for diagnosis

If you are hospitalized for diagnostic or evaluation purposes, you are not covered by your health insurance policy.

To sum up, health insurance policies are helpful in case of medical emergencies. However, it is important to take a good look at what your policy covers before opting for one.

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