Things That Are Not Covered Under Health Insurance Policy

4 min read

Exclusions in Health Insurance Plan in India

There are certain covers that you thought are not included under your health insurance plans but you can actually avail coverage for them. Let us find out more about them in this blog.

It is very important to ensure that you know all the expenses that are covered under your health insurance before you buy a plan. Many health insurance companies do not cover certain charges. On the other hand, there are some covers which you thought were not included under your health plan but you can actually get coverage for them. Let us learn about such covers here.

Among the various charges that are not covered under health insurance policy include the costs of  diagnostic tests, cosmetic surgery, alternative therapies, infertility complications etc, which we will learn about in this blog.

However, there are some exclusions that an insured can add as riders to their health plan to avail their benefits. Let’s discuss some such coverage that you can buy as an add-on rider by paying an extra amount.

Diagnostic tests charges

One such charge is that of diagnostic tests that almost every person has to undergo while visiting a doctor and seeking medical help. This is because every time you visit physicians for any particular medical condition, they prescribe different diagnostic tests before finally confirming your ailment. Being too expensive, people like to have coverage for such tests so that they can undergo these tests without making a hole in their pocket.

Diagnostic tests can be any tests that the doctor prescribes to verify or to rule out any disease or health condition of a patient. These can be invasive or non-invasive and the charges for such tests vary depending on the kind, process and the advanced technology used to get such tests done.

Some of these tests are –  X-Rays, MRI, Ultrasound, CT scans, Fluoroscopy, PET scans, Mammography, Biopsies etc.

The charges of these tests are quite expensive and might be difficult for people to afford on a frequent basis. Moreover, since most of the times when we visit a doctor, we are advised to get a few such tests to confirm the condition of our health. So, affording such tests every time becomes difficult financially.

Can an insured get covered against Diagnostic costs? How?

There are many insurance companies offering coverage for many diagnostic tests. Some of them are blood tests, X-rays, MRIs etc. However, these tests are compensated only if the insured person availing of these expenses is admitted to the hospital for 24 hours and above.

Further, there are certain ways in which you can avail benefits of diagnostic costs coverage without getting hospitalized as discussed below:

  1. By procuring OPD Cover – if you avail the OPD cover, which many insurers are offering these days, you can claim many costs that are not incurred while you are hospitalized.  Some of these costs include costs of pharmacy, diagnostic tests costs prescribed during regular check-ups etc. However, it depends on the insurer about what all charges they are offering. Most of these OPD covers allow the insured to claim reimbursement numerous times during the duration of the policy. Thus, health insurance with OPD cover allows you to save enough money on diagnostic costs.
  2. By choosing a cover on Preventive Health Check-ups – Depending on your healthcare needs, you can choose a preventive health check-up plan. With this plan, you can keep a check on your health at a cost effective premium and lower the scope of critical and other ailments.

Further to the above, there are many health plans that allow preventative health check-ups for free at the time of policy renewal.  Some of the tests that are covered under such preventive check-ups are namely, lipid profile, pap smear, pelvic exam, cancer screenings, heart disease screening, and dental check-up etc.

Exclusions of Health Insurance plans

Now let us discuss some of the common exclusions of a health insurance plan:

  1. Cosmetic Surgeries – Botox, implants, liposuction etc. are some of the cosmetic surgeries that are not covered under a health insurance plan. However, if any such surgery is done as part of a treatment, it is covered by your insurer.
  2. Infertility Complications – Complications related to infertility such as abortions etc. are not covered under your health insurance even if the insured gets hospitalized for the same. However, some insurers might cover them under maternity health plans. So, it is best to check with your policy provider.
  3. Health Supplements – Your health insurance does not offer coverage against supplements that you buy for your health like tonics etc. However, if your doctor suggests such supplements as part of your treatment, they might be covered by the insurer. So, here again you have to seek help from your insurer to get the details.

Ailments caused due excess consumption of alcohol

If overconsumption of alcoholic substances is the cause of your disease, it might not be covered by your insurer.

Alternative Therapies Expenses

Costs that you may incur on alternative therapies such as acupressure, naturopathy, reflexology, etc. are also not covered under your health insurance coverage.

Also Read: Are Diagnostic Charges Covered by Health Insurance Policy 

To Conclude 

So, as discussed above there are certain charges that are not covered under health insurance. Further, there are certain expenses that can be availed by buying additional coverage. Also, it entirely depends on the insurer and the insurance policy as to what all coverage they allow or not. So, it is important to compare, read and understand your policy details well before buying your health plan so that you can get better coverage and protection under your health plan.

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Gayatri Prabhu, Head-Digital Business at Mahindra Insurance Brokers Limited (MIBL) is one those few digital leaders who has the width and depth that is required to execute an ROI driven holistic digital strategy. She cuts through the noise, identifies the critical levers and leads her team to successful execution of the defined strategy. Her core mantra to win new and retain existing customers is: understand the consumer behavior and craft experiences around it.

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