Which Disease is Not Covered in Health Insurance?
The health of an individual is the most important thing in anyone's life and to protect it there is health insurance available in the market. Buying health insurance at a young age comes with lots of benefits. There are certain diseases that are not covered by health insurance and are mentioned in the exclusion of the policy document. Certain diseases get included in the health insurance policy by taking riders for which customers have to pay extra premiums and companies exclude some diseases permanently and do not provide coverage for those diseases.
Table of Contents
Common Exclusions in Health Insurance Plans
Some exclusions are common in health insurance plans offered by every insurer and they don't get covered in the policy. These exclusions are:
1. Pre-Existing Diseases (PED)
Pre-existing diseases are the diseases that exist in the body of the policyholder before buying health insurance. There are waiting periods of 2-4 years for every PED and they differ from one insurer to another. Serving the waiting period is mandatory for every policyholder.
2. Injuries Due to Alcohol/Drug
Injuries or any accident caused due to the consumption of alcohol or any drug are not covered by the insurer in health insurance. This is the common exclusion which is available in all the health insurance plans of all the companies.
3. Transmitted Disease (AIDS/HIV)
Any disease that is caused by transmissions like AIDS and HIV is not covered by the health insurance company.
4. Cosmetic Treatment
Health insurance does not cover the treatment that is done to enhance the appearance and to bring change to the body. Cosmetic treatments like plastic surgery, breast enhancement, body contouring etc are not covered by health insurance.
5. Dental Treatment
Health insurance companies do not provide coverage for dental treatment until and unless it is caused by an accident.
6. Intentional Injuries
Any injury that is caused or done by an individual to harm themselves is not covered by health insurance because it is not accidental, it is done intentionally.
What are Pre-existing Conditions?
Any disease, illness or injury that existed in the body of an individual before buying the health insurance is known as a pre-existing disease or condition. There are certain diseases that come under pre-existing conditions and health insurance providers either exclude these diseases or keep a long waiting period to give coverage for their treatment. The diseases that are considered in pre-existing conditions are diabetes, asthma, cancer, heart disease, and hypertension.
Specific Diseases Often Excluded in Health Insurance
Health insurance companies exclude some diseases from health insurance and do not provide coverage for those diseases.
1. Chronic and Lifestyle Diseases
Chronic and Lifestyle Diseases are diseases that are non-communicable and caused due to the lifestyle and habits of an individual. The main reasons for these diseases are lack of physical activity, unhealthy eating, smoking and consumption of alcohol. Diseases like cancer, asthma, type 2 diabetes, liver diseases, heart diseases, arthritis etc come under chronic and lifestyle diseases.
2. Congenital Diseases
The diseases which are available in the human body from the time of birth are known as congenital diseases. Health insurance companies exclude this disease because it is a permanent kind of disease and one has to suffer the whole life because of that disease. Cleft lift and cleft palate, heart defects like a hole in the heart, atypical limbs etc are congenital diseases.
3. Maternity and New Born Care
Maternity and newborn care are often excluded from health insurance by some companies. There are companies that keep waiting periods for maternity coverage and expenses of newborn care and policyholders have to serve that waiting period.
4. Dental and Vision Care
Treatment of dental and vision care is not included in the health insurance. An individual has to bear the expenses of medical treatment related to dental problems and vision care unless and until it is caused by an accident.
5. Cosmetic and Elective Procedure
It is a kind of treatment which is done to alter the natural appearance and health insurance companies do not cover the medical treatment expenses that are done to enhance the physical appearance.
Options for Covering Excluded Diseases
As per the Insurance Regulatory and Development Authority of India (IRDAI), certain diseases are excluded from health insurance and their medical expenses are not covered by the insurer. But there are options available for some diseases and medical treatment which gets added to the insurance as a rider by paying an extra premium.
There are waiting period clauses for some diseases which are to be served by the insured person to get monetary coverage for treatment of that disease.
Diseases for which you can get coverage by taking riders are:
Maternity Rider: Under this rider coverage of maternity is given which includes the expenses related to pregnancy and childbirth. From delivery to pre and post-natal care gets covered by the insurer.
Critical Illness Rider: If you take a critical illness rider then the insurance company will provide you with a lump sum amount for the treatment of the disease.
Tips for Choosing the Right Health Insurance Plans
There are a few things that every individual should look at and consider before purchasing health insurance. Please go through the below-given points for choosing the right health insurance plan:
1. Sum Insured
The sum insured is the highest amount given to you by the insurer against the premium paid by you. Always check that the sum insured you will get should be high enough to cover all medical treatment expenses.
2. High Claim Settlement Ratio
The claim settlement ratio of the company is the percentage of claims settled by the insurance company in the given financial year. The high claim settlement ratio of the company indicates that the company pay the claim to its customers when they need it. So always choose the health insurance company with a high claim settlement ratio.
Insurance companies have tie-ups with hospitals in different cities and states where you can get the benefit of cashless treatment. Choose the health insurance company with the highest number of network hospitals.
4. Co-Payment Clause
Some companies have co-payment options in their health insurance plan in which customers have to pay a certain percentage of the bill amount at the time of payment. For example- if there is a 20% co-payment and the bill amount is Rs.1 lakh then the customer has to pay Rs.20,000 and the insurance company will give Rs.80,000. Always choose a company with no co-payment option in their plans.
5. Waiting Period Clause
Companies keep waiting periods for some pre-existing diseases and insured person will get coverage for those diseases only after completion of the waiting period. Waiting period depends on plans and it varies from company to company.
Top Health Insurance Companies and Plans (covering excluded diseases)
|
Health Insurance Company |
Health Insurance Plans |
Excluded Diseases covered |
|
Star Health |
Yes |
|
|
Aspire |
Yes |
FAQs
Ques 1. Which treatment is not covered under health insurance?
Ans. Treatments that are not covered under health insurance are:
- Dental treatment
- Cosmetic treatment
- Treatment of injuries caused by the consumption of alcohol or drugs.
Ques 2. Which of the following is not covered in health insurance?
Ans. Health insurance companies do not provide coverage for any type of treatment.
Ques 3. Is high BP a pre-existing condition?
Ans. Yes High Blood pressure is considered under pre-existing diseases.
Ques 4. Which illness is not covered by health insurance?
Ans. Illnesses like heart attack, cancer, kidney failure, stroke, brain tumour etc are not covered by health insurance.
Ques 5. Which diseases are covered after 2 years in health insurance?
Ans. The insurance company covers pre-existing diseases like diabetes, thyroid, high blood pressure and asthma after completing a waiting period of 2 years.
