Health Insurance

10 Most Common Health Insurance Exclusions

What are Insurance Exclusions? Insurance exclusions are the conditions that are excluded from the insurance contract, and in those cases, the insurance company doesn't provide coverage for them. To…

What are Insurance Exclusions?

Insurance exclusions are the conditions that are excluded from the insurance contract, and in those cases, the insurance company doesn't provide coverage for them. To avoid a few selections of adversity, the insurance companies do not consider providing benefits for specific conditions. But such cases are always clearly stated of commencement of the contract for the information of the policyholder.

In other words, 'exclusions' is a term used to define what's covered in the insurance policy more appropriately. 'Exclusions' eliminate a few specific types of risk. 'Exclusions' narrow the scope of coverage provided by the insurer. This is the reason; it's essential to read policy documents very carefully. Understanding from the insurer's point of view, through exclusions, they carve away coverage for risks they are unwilling to insure.

What is Permanent Exclusion in Health Insurance?

Health insurance covers medical costs such as diagnostic tests, doctors' consultation, bed charges on hospitalization, and medical fees. Health insurance is said to reduce the financial burden of medical emergencies or regular medical expenses. Health insurance also provides financial security at the worst times. Therefore, an investment in health insurance is considered to be a wise decision.

It is always a must to note that the health insurance policy also comes with specific exclusions, just like other insurances. There are generally four kinds of health insurance exclusions. Permanent exclusion tops the list. Permanent exclusions in health policy are listed categories of treatments (for example, chronic disease or a genetic blood disorder) that are never covered in the health insurance policy for the whole life. They are excluded permanently from the scope of health insurance. They are always clearly mentioned in policy documents under 'Permanent Exclusions.' Other than a few treatments, there are also some drugs or some surgeries under which permanent exclusions in health insurance are listed.

Even before buying the policy or signing the policy document, which confirms stated terms and conditions, one can read all the policy documents where all permanent exclusions in health insurance are stated. Most companies have a list of illnesses listed under this section. 

10 most common exclusions in Health Insurance policies:-

  1. Pre-existing medical conditions: In case of any pre-existing medical condition that the policy beneficiaries are suffering from at the time of policy commencement, it is usually excluded from the policy coverage. However, many of these pre-existing diseases get included in the coverage after the completion of a waiting period of not more than about 4 years. Whether the insurer consists of a specific pre-existing condition into the policy scope after the waiting period depends on their terms and conditions and the health condition of the insured.
  2. Any medical treatment not involving hospitalization: Outpatient treatment, medical tests, and health check-ups are not included. These may include outpatient therapy, health check-up, specific medical tests, and certain medicines. However, these get easily covered if they get hospitalized. Sometimes, some medical insurance companies offer free complete annual health check-ups as a part of the policy.
  3. Alternative treatment: Health insurance policies do not cover treatments in alternative ways like homeopathy, acupuncture, acupressure, and yoga.
  4. Cosmetic treatment: This includes any form of cosmetic treatment like plastic surgery for enhancing the looks of an individual. These are usually excluded from a health insurance policy. However, a cosmetic treatment following an accident faced by the insured, which results in hospitalization, will generally be covered.
  5. Intentional injuries: Any form of intentional injuries (like the ones resulting from a suicidal attempt) is excluded from a health insurance policy.
  6. Any transmission-related diseases: Any transmission-related diseases like HIV or AIDS are among the most common permanent exclusions from any health insurance policy.
  7. Congenital disorders: Health insurance policies usually never insure any medical treatments present from birth, which means the insurance doesn't cover any genetic diseases.
  8. Pregnancy & Childbirth: Several standard health insurance plans most commonly do not cover maternity expenses. They may be covered under individual health insurance plans. To get that coverage, it might be needed to add a special add-on sometimes. But costs for treating infertility and abortion are not commonly covered under any medical insurance.
  9. Lifestyle-related conditions: Treatment of diseases related to the lifestyle of the insured is excluded under standard health insurance plans. A few such conditions include lung diseases arising from smoking, cirrhosis, or any kidney diseases arising from alcohol consumption.
  10. Treatment of mental illness: Costs of treatment of mental illness, stress, psychiatric or psychological disorders. 

Other than these new standard health insurance exclusions, sometimes, the use of hospital phones, TV, or extra pillows during hospitalization comes under standard exclusions in health insurance policies. The treatment of disorders like dyslexia also comes under permanent exclusions in health policy. 

Conclusion on Health Insurance Exclusions:

It will be worthwhile to re-emphasize that health insurance policies differ from one another. That is why one must read all the insurance documents very carefully before planning. It will give clarity about what is included and what is not included in the policy. It is also wise to compare multiple policies from different insurers before deciding.

It is always better to opt for a complete policy with crucial add-ons like cover for critical illness, pre-and post-hospitalization. That is why it is often not good to go for a basic system. For that, most importantly, one needs to know all the insurance policy plans accurately.

Must read: What are the benefits of Family Floater Health Insurance Plan?


Q. What are the exclusions of health insurance policies?
A. Any health insurance plan will not cover everything, and there are always some exclusions. Important to note is that you must read all your terms and conditions before buying a health insurance policy.

Q. What are common exclusions in a health insurance plan?
A. 5 most common exclusions are:

  • Dental and hearing
  • Pregnancy
  • Cosmetic Surgery
  • Pre-existing diseases
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