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Health Insurance

Important Aspects Of Health Insurance

Policy Inclusions

Not all insurance policies promise you everything. Knowing which policy allows you certain benefits is equally important as understanding the exclusions of each policy. For example, policyholders can seek claims on 30 days pre-hospitalisation and 60 days post-hospitalisation while treatment of sexually transmitted diseases does not fall under the purview of any health insurance plan. 


Other policy inclusions are prolonged coverage for as long as two years from the date of policy inception, wide coverage, claims on expenses towards in-hospitalisation treatment, the amount spent on daycare procedures, costs of domiciliary treatment, restoration benefits and a separate cover for critical illnesses in lieu of added premium payments on health add-on covers. 


Policy Exclusions

Despite the growing importance of health insurance in today’s times, customers prefer to compare only the premium rates and their coverage amount promised by each insurance company. While it is an understood fact that one buys health insurance to pay for medical costs in the long run and, thus, ease possible financial burden stemming from elevated healthcare costs, there are certain claims that no insurance company would entertain. Such claims made on various treatments for various reasons are excluded from the purview of most health insurance plans, though the same is subject to the terms and conditions of each insurance company.


Common policy exclusions are:


  • Waiting period exclusions: Waiting period is particular to each insurance company. However, one exclusion concerning the waiting period common to every insurer is that no company pays towards claims made on treatment expenses carried out within the first 30 days of policy inception. 
  • Pre-existing disorder treatment: The waiting period for pre-existing disorders ranges from 30 days to four years. However, there are certain diseases included in the list of pre-existing disorders of each insurer. The claims raised on the treatment of these are covered only after three years of paying the first policy premium.  
  • Sexually transmitted diseases treatment: Any expenses incurred on the treatment of diseases like HIV or AIDS cannot be claimed under any health policy scheme sold by any insurance company. 
  • Injuries sustained during war or terrorism: Injuries or disorders resulting from any kind of war or terrorist activities will not be covered under any health plan, thus, implying that policyholders are required to pay for such treatments themselves. 
  • Treatment of addiction problems: Treatment of drug-induced diseases or any illnesses caused by dependence on cigarettes, alcohol or any kind of narcotic substance are not covered under any health insurance policy. This is an exclusion common to all health insurance plans sold in India. 
  • Dental care treatment expenses: The treatment of dental care is not covered under any health plan. 
  • Cosmetic surgeries: Health plans are bought to tackle sudden emergencies and not for defraying costs on surgeries carried out to enhance beauty. While there are many health plans that cover expenses on plastic surgeries, none of them covers the costs of cosmetic surgeries. 
  • Investigative treatment: Some people tend to participate in medical surveys or give themselves up for medical experiments carried out by various research centers and pharmaceutical companies. Sudden investigative procedures may result in the policyholders afflicted with disorders of the body or mind. Treatment of such diseases is not covered under any health insurance plan sold by any insurer in the country. 

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