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General Health Insurance Plan Exclusions

The exclusions on a health insurance plan vary from company. Pay attention to is whether pre-existing diseases or treatment for common but expensive treatments, such as cataract or hernia are covered.

Apnainsurance.com Research Bureau

03 Dec 2007

The exclusions on a health insurance plan vary marginally company to company - what one should pay special attention to is whether pre-existing diseases or treatment for common but expensive treatments, such as cataract or hernia are covered.

The typical expenses that are not covered by a general health insurance policy are:

  • Any disease/injury during first 30 days of commencement of policy (except accidental injury)
  • Any treatment relating to any illness/disease already in existence at the time of proposal; certain policies may cover a few pre-existing diseases from the fourth, fifth or sixth year onwards; provided the policy is renewed with no lapse
  • Expenses incurred on treatment of following diseases within the first two years from the start date of the policy are not covered, but would be covered from the third or fourth year onwards or later if they are pre-existing covers:
  • Arthritis
  • Benign prostate hypertrophy
  • Cataract
  • Dialysis required for chronic renal failure
  • Dilatation & curettage
  • Fistula in anus
  • Gastric and duodenal ulcers
  • Gout
  • Hernia
  • Hydrocele
  • Hysterectomy unless because of malignancy
  • Joint replacement (unless due to accident)
  • Myomectomy
  • Piles
  • Rheumatism
  • Sinusitis and related disorders
  • Skin and all internal tumors / cysts / nodules / polyps of any kind, including breast lumps, unless malignant / adenoids and hemorrhoids
  • Stone in the urinary and biliary systems
  • Surgery on tonsils and sinuses

Permanent exclusions could comprise of the following illnesses:

  • Vaccination, inoculation, change of life, cosmetic or aesthetic treatment, plastic surgery unless necessitated due to accident or as a part of any illness
  • Treatment of asthma, chronic nephritis and nephritis syndrome, gastro-enteritis, diabetes mellitus and insipidus, epilepsy, hypertension, influenza, cough and cold, all psychiatric or psychosomatic disorders, pyrexia of unknown origin for less than 10 days, tonsillitis and URTI, arthritis, rheumatism (as far as domiciliary hospitalization is concerned)
  • Dental treatment or surgery of any kind unless requiring hospitalization
  • Cost of spectacles contact lenses and hearing aids
  • Convalescence, general debility, "run-down" condition, sterility, venereal disease, intentional self-injury, use of drugs and intoxicants
  • Hospital / nursing home charges not forming part of any treatment
  • Treatment connected with pregnancy, child birth, voluntary medical termination of pregnancy within first 12 weeks of confinement
  • Nuclear perils and war group of perils
  • Naturopathy or non-allopathic treatment
  • Any internal congenital illness
  • Pregnancy and childbirth related diseases
  • Expenses arising from HIV or AIDS and related diseases
  • Use or misuse of liquor, intoxicating substances or drugs as well as intentional self injury
  • War, riots, strike, terrorism acts, nuclear weapon induced treatment.
See also:

Miscellaneous Health insurance FAQs

Health insurance FAQs about Coverage

Health Insurance FAQs about Claims

Health Insurance FAQs about Premiums

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