What Do You Mean By 'Exclusions' In Health Insurance

Health plans come with a fine print of permanent exclusions in health insurance and can give you one nasty blow at the time of filing a claim if you are caught unawares. Hence, you should be cognizant of them at the time of purchasing the insurance plan. Most people rejoice the benefits of their health plan instead of scanning it for the necessary details they are going to miss out on. You would be dejected upon coming to terms that your dental surgery or some other healthcare procedure is excluded from your health cover. This is why it is crucial to be informed about permanent exclusions in a health policy.

Health insurance exclusions are those ailments and medical procedures that the insurer does not cover under the standard health insurance plan. Insurance companies explicitly exclude such treatments but they could be offered under a different insurance product.

Common exclusions in health insurance policies are explicitly stated under the terms and conditions of your policy document. You should ensure that you read through such permanent exclusions in health insurance to avoid any stress when it comes to availing necessary medical assistance that would not being covered by your insurer.

Permanent exclusion in a health policy has the effect of narrowing the scope of its coverage. You are exposed to certain ailments and medical situations that have no medical coverage under your health plan. Such health insurance exclusions are inserted by the insurer to protect its interests from the exposed risk of health insurance coverage that it needs to provide to the insured.

The regulatory authority, the Insurance Regulatory and Development Authority of India (IRDA), has specified certain exclusions as permanent exclusions in health insurance mentioned under Chapter IV of the Guidelines on Standardization of Exclusions in Health Insurance Contracts.

An insurer may exclude risks for various reasons as mentioned below.

Events like a war that can lead to a large number of claims made by the affected people can have an impact on the insurer. Such events are excluded to protect the interests of the insurer

Specific medical treatments may be included in other insurance products as separate medical cover offered by the insurer. It is the reason why your insurer may exclude a particular treatment under your health plan and provide a separate health plan that covers the disease/ailment.

Most health insurance plans have common exclusions in health insurance policies for availing treatment from non-registered medical practitioners. This is to protect the insurer and so that policyholders avail the necessary medical assistance from registered medical practitioners only.

It is imperative that you are aware of your health insurance exclusions so as to take proper measures to mitigate their effects. One must ensure that the common exclusions in health insurance policies are something they are familiar with before buying a health cover.

Reading the above must have gotten you familiar with health insurance exclusions. You can read more about such key terms under our health insurance glossary articles on our website. Click here to know more on topics like meaning of Insurer, Dependents in Health Insurance”, and more!

Stay safe and stay insured.