Here's What Your Health Insurance Doesn't Cover and Why It's Just as Important

Introduction

If there ever was a time to invest in Health Insurance, it is now. The Coronavirus pandemic has only highlighted its value. Medical expenses have increased by leaps and bounds and by availing a medical insurance, individuals can be assured of financial security, if they have to incur medical or surgical expenses, cost of prescription drugs, and on occasions, dental expenses. Today, Health Insurance is viewed as a necessary expense, which one usually shells out from one’s hard-earned money. As an individual continues to age, the necessity of this insurance increases, as the likelihood of running into expenses arising due to illnesses or injuries increases manifold. At the same time, it is important to know what your Health Insurance policy will not cover.

Health Insurance doesn’t Cover all Expenses

While medical insurance covers medical and surgical expenses, prescription drugs and occasional dental expenses, there is a broad spectrum of medical expenses not covered by insurance plans. When individuals purchase these plans, they don’t always read the fine print carefully. Moreover, they might get swayed by the brand name the insurance company carries with it. They might also get impressed with the claim-settlement ratio the Health Insurance company boasts of and markets. Claim settlement ratio refers to the percentage of claims an insurer has settled during a financial year, stacked against the number of claims it received in the same period, along with the claims carried over from the previous year. While a Health Insurance company can in fact have a high claim settlement ratio, it is most likely due to the fact that those insured under it only sought to avail claims on services the insurer explicitly stated it would cover. Eager purchasers might rush in to purchase Health Insurance policies from such companies without considering whether or not their required expenses are included in the coverage or not. It is therefore important that individuals understand what isn’t ordinarily covered in Health Insurance plans so that they aren’t caught unaware in the future.

What’s not included in most Health Insurance policies

Listed below are some of the more popular expenses that most Health Insurance companies do not ordinarily cover in their policies.

1. Pre-existing Diseases – When considering the list of diseases not covered under Health Insurance in India, it is important to consider this. Expenses arising from diseases diagnosed, surgeries presently being undergone and/or any symptoms or signs of a disease, which occur within 30 days of the policy being enacted, aren’t provided coverage for by most insurance policies
2. Self-inflicted injuries such as suicide or attempts at suicide do not merit coverage by most Health Insurance policies
3. Medical expenses arising from the consumption or abuse of any alcohol or drugs, do not ordinarily receive any coverage by most Health Insurance policies
4. Expenses related to pregnancy and voluntary abortion are not included in most Health Insurance plans. This includes caesarean deliveries, as well as complications which might arise at any point during a pregnancy. Only in the unfortunate event that an abortion is deemed a medical requirement, as the mother’s life is under threat, some policies may provide coverage. Here, a medical practitioner is required to present the case to the insurance company
5. Hospitalisation induced from war, riot, strike, and nuclear weapons are not included under almost any Health Insurance policies
6. Fertility treatments like in vitro fertilisation (IVF) as well as medical tests and treatments relating to infertility, are not ordinarily included in Health Insurance policies
7. Cosmetic procedures that can enhance an individual’s external appearance, such as plastic surgery and a handful of dermatological procedures, aren’t ordinarily included in healthcare plans. This is largely because they are voluntary procedures that don’t arise from any life-threatening need
8. New technology utilised in medical products or services is not always covered and if it is, insurance companies might take an additional period of time to provide coverage. This holds particularly true in the case of medical products and services which do not showcase added benefits, consistent with the price hike.

Conclusion

Individuals must consider what their pressing medical expenses might be. After assessing them, they must consider the Health Insurance policies available in the market and read the fine print before purchasing their policy. There are a number of ways in which individuals can avoid spending extra money, provided they know what to look for. Young couples hoping to be with a child within the next 2 to 4 years for instance, can avail specialised Maternity Insurance policies that help reduce their medical expenses. Similarly, those with pre-existing diseases can look up the waiting period during which Health Insurance policies don’t provide coverage and seek out those that have a minimum waiting period. Else, they can invest in Health Insurance policies that are designed to cater to the expenses arising from the disease they suffer from. Certain plans also allow for medicines covered by insurance.

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