subject: What Aspects Are Not Covered By A Health Insurance Company? [print this page] Many policy holders end up disappointed with their medical insurance when they attempt to make a claim. Learning about the various exclusions of the policy at the end moment leaves consumers with a bitter experience. This happens because most of the time consumers tend to buy a policy without paying attention to the terms and conditions. Every health insurance company clearly mentions their exclusion in the documents of the insurance policy. If you take a policy without reading through them, be ready for an unpleasant surprise.
Lets take a look at some common exclusion clauses in a medical insurance policy. Companies have started innovating this list by avoiding exclusion of certain ailments that were originally not included by health insurance policies
No cover for first 30 days
When you purchase a medical insurance, the health insurance company does not offer you cover for any hospitalization or medication in the first 30 days of the policy. This is known as a window period. In this duration you can opt to cancel the policy and opt for another product.
Diseases excluded
Medical insurance plans cease to offer cover for a number of diseases. These include Cataract, Prostrate, Hernia, Piles, fistula, gout, rheumatism, kidney stones, tonsils and sinus related disorders, congenital disorders, drug addictions, non allopathic/alternate treatments, self inflicted injuries, hysterectomy, fertility related treatments, etc. Policies also do not offer cover for dental treatment and cosmetic surgery. Plus the cost of contact lenses is not covered. A very debatable exclusion is that of HIV/AIDS. Also, some policies do not offer cover for treatments taken outside the country.
No cover for pre-existing diseases
Pre-existing diseases of the policy holder are not immediately covered with the effect of the policy. Pre-existing disease is a health condition that the policy holder is suffering from before buying policy. Also, further complications caused due to this health condition will not be covered. For e.g. a person suffering from renal problem due to a precondition of diabetes. The health insurance company can turn down the claim for this by saying that the problem has arisen because the patient had diabetes, before the policy was bought. Policies mostly tend to cover pre-existing diseases after 3 or 4 consecutive policy years.
The above criteria are the basic exclusions that health insurance companies follow. With change in time and demand of the consumers, some of the exclusions have been tweaked to include in the policy. So, before investing in a medical insurance be sure to read the documents carefully and make an informed decision.
by: gianyadav
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