| The
exclusions on a health insurance plan vary marginally company to company - what one
should pay special attention to is whether pre-existing diseases or treatment
for common but expensive treatments, such as cataract or hernia are covered.
The
typical expenses that are not covered by a general health insurance policy are:
- Any
disease/injury during first 30 days of commencement of policy (except accidental
injury)
- Any
treatment relating to any illness/disease already in existence at the time of
proposal; certain policies may cover a few pre-existing diseases from the
fourth, fifth or sixth year onwards; provided the policy is renewed with no
lapse
- Expenses
incurred on treatment of following diseases within the first two years from the
start date of the policy are not covered, but would be covered from the third
or fourth year onwards or later if they are pre-existing covers:
- Arthritis
- Benign prostate hypertrophy
- Cataract
- Dialysis
required for chronic renal failure
- Dilatation
& curettage
- Fistula
in anus
- Gastric
and duodenal ulcers
- Gout
- Hernia
- Hydrocele
- Hysterectomy
unless because of malignancy
- Joint
replacement (unless due to accident)
- Myomectomy
- Piles
- Rheumatism
- Sinusitis
and related disorders
- Skin
and all internal tumors / cysts / nodules / polyps of any kind, including
breast lumps, unless malignant / adenoids and hemorrhoids
- Stone
in the urinary and biliary systems
- Surgery
on tonsils and sinuses
Permanent
exclusions could comprise of the following illnesses:
- Vaccination,
inoculation, change of life, cosmetic or aesthetic treatment, plastic surgery
unless necessitated due to accident or as a part of any illness
- Treatment
of asthma, chronic nephritis and nephritis syndrome, gastro-enteritis, diabetes
mellitus and insipidus, epilepsy, hypertension, influenza, cough and cold, all
psychiatric or psychosomatic disorders, pyrexia of unknown origin for less than
10 days, tonsillitis and URTI, arthritis, rheumatism (as far as domiciliary
hospitalization is concerned)
- Dental
treatment or surgery of any kind unless requiring hospitalization
- Cost
of spectacles contact lenses and hearing aids
- Convalescence,
general debility, "run-down" condition, sterility, venereal disease,
intentional self-injury, use of drugs and intoxicants
- Hospital
/ nursing home charges not forming part of any treatment
- Treatment connected with pregnancy, child birth, voluntary medical
termination of pregnancy within first 12 weeks of confinement
- Nuclear
perils and war group of perils
- Naturopathy
or non-allopathic treatment
- Any
internal congenital illness
- Pregnancy
and childbirth related diseases
- Expenses
arising from HIV or AIDS and related diseases
- Use or misuse of
liquor, intoxicating substances or drugs as well as intentional self injury
- War, riots,
strike, terrorism acts, nuclear weapon induced treatment.
See also:
Miscellaneous Health Insurance FAQs
Health Insurance FAQs about Coverage
Health Insurance FAQs about Claims
Health Insurance FAQs about Premiums
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