The term exclusion is used in health insurance when an event of medical emergency/need is excluded from an existing health insurance policy. There are many types of medical conditions that are not covered by your health insurance policy; therefore, it would be good for you to read carefully what does your policy cover and doesn’t cover? Usually, after buying a health insurance policy, insured receives a copy of terms and conditions along with a list of doctors in his network through email or post. It is immensely important to read all terms and conditions related to a health insurance policy to minimize the chances of claim rejection. It is remarkable that insurance companies strictly follow their terms and conditions stated in specific policy; which means customer’s claim will be rejected if claimed medical emergency is not stated in their terms and conditions page. Therefore, it is advisable that after buying a health insurance policy promptly read all terms and conditions of your policy to understand what does your policy cover and doesn’t cover? You may request your insurer to send a copy of terms and conditions before buying a health insurance.
Disclaimer: The information and benefits provided herein are for informational purpose only and you may find some variations in exclusions. Please do not take it as a legal advice.
30 Days Initial Waiting Period
Often, insurance companies do not provide health cover for medical expenses for first 30 days of the policy; unless the cover needed for injury caused by an accident. As per 30 days initial waiting period, your insurer is not liable to pay you any claim for medical expenses in first 30 days of the policy. This rule does not applicable in subsequent years. The waiting period does not reapply when the policy is renewed; except policy is renewed after a break. Incase policy is renewed after a break then waiting period will reapply on revived policy as like first year.
Pre-existing Medical Conditions
Waiting Period For Certain Illnesses
- Joint replacement; unless due to accident
- Piles or Gastric and Duodenal Ulcers
- Stones in biliary and urinary systems
- All types of Hernia and tumors
- Gout/Arthritis/ Rheumatism/Osteoarthritis/Disc Prolapse
- Dilation and Curettage
- Varicose veins
- Laser surgery
- Benign Prostatic Hypertrophy
- Surgery on tonsils/adenoids
- Any type of life support system which cannot restore previous state of health.
- Treatment for any illness or injury due to war, nuclear war, riot, chemical contamination, acts of terrorism etc.
- If insured person deliberately puts himself/herself in danger situations.
- If insured is staying in hospital without requiring any type of treatment.
- Cosmetic Surgery: If insured person wants a cosmetic surgery to improve his/her appearance.
- Dental/Oral Treatment which does not require to be hospitalized.
- No claim for eye related issues unless insured needs to be hospitalized due to accident.
- If insured person gets sick due to taking treatment from wellness clinics, natural cares or in other words place that is not a hospital.
- HIV and AIDS: Treatment required for Human Immunodeficiency Virus or Acquired Immuno Deficiency Syndrome.
- If insured suffering from a genetic disorder or problem.
- Illness due to drug overdose.
- Getting extra treatment from private bodies on pre and post-hospitalization.
- If medical officer or doctor gives fitness certificate that insured is capable of pursuing his/her life as before illness.
- No payouts for treatments from streams like; ayurvedic, homeopathic etc.
- Treatment of obesity.
- Self-inflicted Injuries.
- Sexual Problems and gender related problems.
- Speech and Sleep Disorders.
- If insured person is getting treatment to reduce the symptoms of ageing.