Medical issues due to External Events
Intentional injuries and injuries due to war, nuclear attacks and terrorism are usually excluded from health insurance. Diseases or health conditions due to HIV, congenital diseases and usage of drugs and alcohol are not covered.
Health issues or medical conditions that arise from diseases that were existing prior to purchase of insurance policy are not covered by the policy with immediate effect. These are called pre-existing diseases. They are usually covered after 2-4 years of the policy being in force continuously. There might be some other terms and conditions as well.
For example, ICICI Lombard's iHealth insurance policy covers pre-existing diseases after 24 months of continuous coverage for the sum assured of Rs. 2,00,000 and above and after 48 months of continuous coverage for sum assured less than Rs. 2,00,000.
In Apollo Munich's Optima Plus plan, pre-existing diseases are covered after 48 months of policy coverage.
Most policies do not cover illnesses or diseases within 30 days of purchase of policy. This clause is waived for accident.s Some illnesses or diseases have a specific waiting period which might be more than 30 days. It could extend from 12-24 months.
For example, ICICI Lombard's iHealth insurance policy has a waiting period of 2 years for claims arising from conditions such as cataract, hernia, arthritis, sinusitis etc. Bajaj Allianz's policy – HealthGuard – Silver plan has a waiting period of 24 months for claims that arise due to gastric ulcers, sinuses, cataracts, hernia and haemorrhoids.
Many insurance policies do not cover pregnancy and related conditions. If you are thinking of starting a family, you should consider this clause. Some policies cover pregnancy related claims after continuous coverage for a certain duration. For example, Bajaj Allianz's HealthGuard – Gold plan covers pregnancy and related conditions and treatments after 72 months of continuous coverage. ICICI's iHealth plan dies not cover expenses related to pregnancy, abortion miscarriage and other related conditions.
Some insurance companies offer specific maternity plans.
Surgeries like cosmetic surgery, dental surgery, joint replacement, skin related surgeries are usually in the list of permanent exclusions of health insurance policies.
Alternative treatments include the AYUSH treatments - Ayurveda, Unani, Siddha and Homeopathy Many insurers do not cover them. Some insurers do offer some amount of cover. For example, Royal Sundaram LifeLine Health Insurance Plan covers Ayush treatment up to Rs. 50,000 if the treatment is done in a government hospital. Max Bupa Health Companion Plan covers AYUSH treatment in case of inpatient hospitalization. If the treatment is done in a government hospital, one can claim up to the sum assured but can only claim up to Rs. 20,000 in case of inpatient treatment in a private hospital.
It will be frustrating to know that you cannot make a claim when you face a particular medical condition and then find out that you are not covered by the insurance policy that you have. Therefore, do remember the following tips -
- Read the brochure and policy document carefully.
- Ask questions about the policy and its features if you have concerns.
- Be aware of the medical conditions, excluded from your health insurance policy.
- Port to a better insurance policy if there are too many permanent exclusions in your current policy.