What are permanent exclusion in health insurance?

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What are permanent exclusion in health insurance?

In health insurance, there are few sections under which no claim is given. Apart from this, there are few things in Mediclaim under which there is a waiting period. There are a few types of health issues under which a person cannot buy a health insurance plan.

Permanent exclusions in health insurance

In the health insurance industry, there are few sections under which a claim is not provided.

List of Permanent exclusions in health insurance

  • Any condition directly or in directed related to sexually transmitted diseases such as AIDS.
  • Any treatment related to pregnancy, abortion, miscarriage or any other related treatment.
  • Any dental treatment or surgery is not covered unless it is due to an injury.
  • Any eye check-up, contact lens or ear examination is excluded.
  • Sleep disorder
  • Mental illness, psychiatric, depression, psychological disorder or any stress-related issues.
  • Treatment-related to change in gender or change in sex.
  • Self-injury or suicide attempt related to medical issues.
  • Hospitalization for a primary purpose like for investigation or to diagnose something.
  • Aesthetic and cosmetic treatments like beauty related surgery is not covered.
  • Surgeries such as joint replacement, cosmetic surgery, dental surgery, are usually not covered in a health insurance policy.

There are other exclusions also depending upon the policy, so it is advisable to read all the documents that you receive with your health insurance policy.

List of diseases under which a person cannot buy a health insurance policy.

  • Cancer – A person who is having cancer or who was having cancer earlier is not eligible to buy a health policy.
  • High Blood Pressure – In the case of high blood pleasure it is difficult for a person to buy a health policy. It will depend on the underwriting weather he can buy a health plan or not.
  • Diabetic Patients – If you are diabetic, then you are not eligible to buy a health plan but you still it will depend on underwriting.
  • Organ transplant – depends upon underwriting.

In case you are using a Bank or corporate policy you cannot port your policy, you have to buy a new policy with all the exclusions and waiting period. So, in such case, it is advisable to use a backup health policy.

Waiting Period under Health Insurance

There are two types of the waiting period in health insurance.

Waiting period for Specific diseases in Health Insurance

There are a few diseases which have a fixed waiting a period of 2 years. This rule is applicable for almost all the plans of all the companies. The waiting period is not applicable when you port (change company) your health policy. But, when you buy a new policy you have to face the waiting period of 2 years. In some separate plans this rule mind is not applicable but in most policies this is applicable.

List of specific diseases in Health Insurance

  • Cataracts, laser surgery or other eyes related issues.
  • Benign prostatic hypertrophy
  • Hernia
  • Hydrocele
  • Fissure/Fistula in anus
  • Piles (Haemorrhoids)
  • Sinusitis and related disorders
  • Polycystic ovarian disease
  • Non-infective arthritis
  • Pilonidal Sinus
  • Gout and Rheumatism
  • Hypertension and related complications
  • Diabetes and related complications
  • Calculus diseases
  • Surgery of gall bladder and bile duct excluding malignancy
  • Surgery of genito-urinary system excluding malignancy
  • Surgery for prolapsed intervertebral disc unless arising from an accident
  • Surgery of varicose vein
  • Hysterectomy
  • ENT disorders
  • Tonsillectomy
  • Adenoidectomy
  • Mastoidectomy
  • Tympanoplasty
  • joint replacement (more than 2 years waiting period depending upon plan/company)
  • Osteoarthritis and osteopo (more than 2 years waiting period depending upon plan/company)

Waiting period for pre-existing diseases in Health Insurance

This is a waiting period which is applicable to fresh policy. In the case of porting the health policy, the waiting period is not applicable. The waiting period for Pre-Existing diseases is generally for 4 years. But depending upon the company and plan it can vary from 2 to 4 years. In some special plans or Top up plan there is a waiting period of 1 year also.

Conclusion: Health Insurance should be taken in advance as it is fully functional after 2-4 years. Permanent exclusions should be kept in mind and It will be better to get under hospitalization contact company once to know about the diseases will be accepted for claim or not. Accidental cases are accepted from the 1st day and after 30 days your health policy will work for normal illness. But for major surgeries, you have to wait to complete the waiting period. You can buy a health policy of less Sum Insured and later you can increase it before taking claim because after taking claim if you increasing Sum Insured you will follow the waiting period for the increased Sum Insured for the particular illness. You can contact your health insurance agent to give you the best plan available in the market. You should also check about the network hospitals before buying the health policy.

30 thoughts on “What are permanent exclusion in health insurance?”

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