Health insurance and mediclaim policy provide financial protection against unforeseen medical expenses. You should be informed that these policies have exclusions and limitations to minimise disappointment when making a claim.
In this blog, you can learn about common exclusions and limitations in health insurance and medical insurance, such as pre-existing conditions, waiting periods, and non-covered medical procedures. Understanding these limitations allows you to make informed decisions when selecting a health insurance policy or a medical insurance that best suits your needs.
What is Healthcare Insurance?
A type of insurance called healthcare insurance covers a person’s medical expenses that arise from illness, injury, or hospitalisation. It is a legal agreement in which you pay the insurance business a premium in exchange for the insurer covering their medical costs.
What are the Exclusions in a Healthcare Insurance?
Some exclusions that limit the coverage offered by health coverage policies are included in the policy. These exclusions can vary depending on the type of policy and the insurance provider.
You should know these common exclusions when buying a healthcare insurance policy.
1. Pre-Existing Conditions
Health coverage policies do not cover any medical conditions that existed prior to the purchase of the health insurance policy. After a waiting period, certain policies can offer you coverage for pre-existing conditions.
2. Cosmetic Treatments
Health insurance coverage does not cover cosmetic treatments and procedures unless they are judged medically necessary, such as reconstructive surgery following an accident or illness.
3. Alternative Therapies
Some healthcare insurance policies may exclude coverage for alternative therapies such as Ayurveda, Homoeopathy, or Acupuncture.
4. Experimental Treatments
Unproven experimental treatments and procedures are not covered by health coverage policies.
What are the Limitations of a Healthcare Insurance?
Healthcare insurance policies have limitations that can affect the coverage provided to you. Knowing these limitations before purchasing a policy is mandatory to avoid any unexpected out-of-pocket expenses. Here are some common limitations of healthcare insurance policies
1. Waiting periods
Most health coverage policies have waiting periods before certain benefits can be availed. For instance, there may be a waiting period of 2-4 years for coverage of pre-existing conditions or maternity expenses.
2. Co-payments
Some health coverage plans claim that you cover a certain portion of the costs of medical care out of pocket. It is called a co-payment and can be anywhere between 10% and 20% of the overall medical costs.
3. Sub-Limits
Health coverage policies may have sub-limits on certain benefits such as room rent, doctor’s fees, or specific medical procedures. It means that regardless of the costs paid, you will only be reimbursed up to a particular sum.
What is a Mediclaim Coverage?
Mediclaim is a type of health coverage policy that provides coverage for medical expenses incurred by you. It is commonly offered in India by various insurance companies. Medical Insurance typically includes costs related to hospitalisation, surgery, and other medical treatments.
The coverage provided by a medical insurance can vary depending on the type of policy and the insurance provider. Some policies may have sub-limits or exclusions that limit the coverage provided. It is important to carefully read and understand the terms and conditions of medical insurance coverage before purchasing. It will help you to understand the coverage provided, the limitations of the policy, and the claim process.
What are the Exclusions in a Mediclaim Coverage?
Medical Insurance policies come with certain exclusions that limit the coverage provided by the policy. These exclusions can vary depending on the type of policy and the insurance provider. The following exclusions, typical of health insurance policies, may also apply to medical insurance coverage.
1. Non-Prescription Drugs
Unless a doctor prescribes them, non-prescription medications, vitamins, and supplements might not be covered by medical insurance.
2. Congenital Diseases
Some medical insurance policies may not cover medical expenses related to congenital diseases or birth defects.
3. Self-Inflicted Injuries
Medical Insurance policies generally do not cover medical expenses incurred due to self-inflicted injuries.
4. War or Terrorism-Related Injuries
Some medical insurance policies may exclude coverage for injuries or medical expenses incurred during war or acts of terrorism.
What are the Limitations of a Mediclaim Coverage?
Medical Insurance policies come with certain limitations that can impact the coverage provided by the policy. Here are some common limitations of healthcare insurance policies that may also apply to medical insurance policies:
1. Geographical Limitations
Some medical insurance policies may have limitations on geographical coverage, meaning that the policy may only be valid in certain regions or countries.
2. Age Limitations
Medical Insurance policies may have age limitations, meaning that coverage may be limited or unavailable to you above a certain age.
3. Medical Examination Requirements
Some medical insurance policies may require you to undergo a medical examination before the policy can be purchased or renewed.
4. Limited Coverage For Pre-Existing Conditions
Even if medical insurance covers pre-existing conditions, the coverage may be limited or exclude certain treatments or medications.
Conclusion
Exclusions and limitations are an inherent part of healthcare insurance policies and medical Insurance, and these limitations may vary depending on the policy and provider.
If you are looking for a reliable and best health insurance company in India, consider Niva Bupa Health Insurance for its comprehensive coverage and excellent customer service. Visit their website or contact their customer service team today to know more about it.
