• En

Health insurance has become a necessity these days owing to the ever-increasing cost of medical services. A good health policy not only saves you from big medical bills but also assures that you get the best possible treatment in case of need. However, not every health insurance policy covers every health condition. Experts repeatedly suggest carefully reading and understanding policy bonds to know which diseases or conditions your health insurance policy will not cover. Then again, policy documents usually contain complicated terms, which may be a bit difficult to understand at times. 

If you too are facing difficulties while trying to understand your health policy bond, read on to know what most health insurance policies tend not to cover. 

  1. Things health insurance does not cover
  2. What doesn’t myUpchar suraksha kawach cover?
  3. Other conditions not covered by health insurance

A health insurance policy covers a lot of things including medical emergencies like an accident or trauma and chronic health conditions. However, your health policy may not be covering all your health needs. Let us have a look at these.

OPD is not covered in health insurance

An OPD is when you see a doctor for minor ailments and injuries like cold, fever and sprains and do not need to be hospitalized. Generally, health insurance companies do not cover OPD. However, you can take OPD cover as a rider by paying some additional premium. Under this, you can get OPD claims up to a certain amount annually. Here are certain things that may be covered under OPD:

1. Lab tests

After a checkup as an out-patient, if your doctor asks you to undergo pathology tests like blood test, urine test, stool test, and saliva test, or imaging tests like X-ray, MRI, CT-scan, then your health insurance company may not cover for these. (Read more: Lab tests types)

3. Over the counter medicines (OTC)

If you go to the chemist and take any medicine, or dietary supplements without a prescription, then an insurance company will not give a claim for it. However, prescribed medications and dietary supplements for hospitalised individuals are covered by health insurance policies.

2. Preventive health checkup

If you are conscious of your health and get preventive health checkup done annually or every six months, then your insurance company may not cover it. Though, nowadays most health insurance companies themselves conduct a preventive health checkup annually. Be sure to ask your health insurance company about this as well. 

Apart from this, vaccination and immunization are also not covered by health policy. Then again, in view of the current COVID-19 outbreak, many health insurance companies are providing claims for corona vaccine in almost all their policies. 

Alternative therapy not covered in health insurance

Alternative therapies are those that you take in place of conventional or mainstream medical treatment. Ayurveda, Homeopathy and Unani medicine are included in alternative therapies.

Most, but not all insurance companies provide cover for alternative therapies. Apart from this, some of the new treatment techniques like robotic surgery, cyberknife and stem cell therapy that is being adopted today are not yet established, are not covered by health insurance policies.

Drug use is not covered in health insurance

If you smoke, consume alcohol or any other intoxicant and have not disclosed it while taking the policy, then the insurance company can refuse to pay the claim in times of trouble. Insurance companies charge you a slightly higher premium from the very beginning to cover diseases caused due to drug abuse. Despite this, drugs are not covered in any insurance policy.

De-addiction treatments are also not covered under health insurance. The insurance company does not even cover the expenses incurred in the process of rehabilitation.

(Read more: Drug addiction treatment)

Treatment at home not covered in health insurance

Before you buy a health policy, do check if it covers home treatment or domiciliary treatment. A lot of health insurance companies do cover home treatment of certain diseases, however, many don’t. Apart from this, your insurance company may not cover less than 24 hours of hospitalisation. However, some policies have day-care treatment cover. For this, you should talk to your health insurance company in advance or read the policy document carefully. 

Repeated specialist visits are not covered in health insurance

If you are hospitalized and visit a specialist more than once a day, most health insurance companies offer cover for only the first visit. You should talk to your health insurance company for more information on this. 

Treatment in blacklisted hospitals is not covered under health insurance

Some hospitals or doctors are blacklisted by health insurance companies because of their bad public image. In case you get hospitalized in a blacklisted hospital or are getting treatment from a doctor that your health insurance company has blacklisted, you may be denied a claim. 

However, in case of an emergency such as an accident or a life-threatening situation, your insurance policy may cover your medical bills until your condition is stable. Once the condition is stable, you should be immediately admitted to a hospital that is in the network of the company.

Pregnancy, birth control and surrogacy is not covered by health insurance

Usually, pregnancy is not covered by health insurance. If you want pregnancy cover in your health policy, you will have to pay an additional premium and there will be a waiting period of 24-36 months before you can make a claim. Apart from this, you will not get the claim even if you have to be hospitalized for miscarriage or abortion. However, the company will give you a claim in case of ectopic pregnancy (pregnancy outside the uterus) and miscarriage due to an accident. Pregnancy is not covered in myUpchar Bima Plus policy.

Birth control not included

Your health insurance will not cover birth control treatments and surgeries such as sterilisation nor will it provide cover reversal procedures for sterilisation surgeries. Additionally, health insurance policies usually do not include infertility treatments such as IVF, ZIFT, GIFT, and ICSI. (Read more: Tubectomy)

Surrogacy

Surrogacy (giving birth to another person's child or getting assistance from a surrogate to give birth to a child) is also not covered by health insurance companies. 

A newborn will not get treatment facility

If you do not have pregnancy cover in your health insurance, then your baby will not get any health cover in the first 90 days after birth. However, if you have taken pregnancy cover, your baby will get health coverage from the first minute of birth. Not only this, but all the vaccines given to the child are also included in this cover.

(Read more: Vaccines for newborns, infants and children)

STDs are not covered by health insurance

Health policies usually do not cover HIV-AIDS and other sexually transmitted diseases (STDs) like genital warts, syphilis, gonorrhoea, genital herpes, chlamydia, pubic lice and trichomoniasis. However, you can get cover for some of these conditions by paying some additional premium. 

Apart from this, surgery related to sex change is also not covered in health insurance. 

Cosmetic surgery is not covered under health insurance

Cosmetic and plastic surgery is not covered in most health insurance policies. Insurance companies also do not provide cover for botox for wrinkle removal, dental cleaning, denture, orthodontics, periodontics and endodontics. 

Your insurance company may refuse to pay the insurance claim in case of an ear or body piercing and tattooing or a need of treatment due to them. 

(Read more: Tattoo removal)

Similarly, laser surgery or any other surgery/procedure for eyesight correction is usually not included in health policies 

However, if you need any of the above treatments due to an accident, your health insurance company cannot refuse to pay the claim.

Mental health is not covered in health insurance

Mental health conditions are not covered in health insurance policies. Whether it is mental retardation, intellectual disability or a problem related to incomplete development of the brain. Apart from this, in case of hospitalisation due to permanent neurological damage, health insurance companies only give claims for the first 90 days. 

(Read more: Mental illness treatment)

Weight loss treatment is not covered by health insurance

If you are overweight (obesity) and want to take any kind of therapy or undergo surgery for it, then your health insurance company will not cover the expenses for you. The same is true for weight gain treatments.

(Read more: 7 common weight loss mistakes)

Sleep disorders are not covered by health insurance

Health policies do not cover the treatment of sleep disorders like sleep apnea syndrome and conditions like boils and pimples. Similarly, you may not be able to claim insurance for hormone replacement therapy

(Read more: Sleep chart by age and gender)

Hair transplant not covered by health insurance

Problems like hair loss and alopecia are not covered in most health insurance policies. If you want to use a product or get a test done to promote or check for hair growth, then your health insurance company may not entertain a claim. Alopecia wigs are not covered under health policies either. 

Acts of self harm or suicide attempts and adventure sports not covered under health insurance

If you get hurt while committing a felony or a suicide attempt or if you are involved in any kind of criminal misconduct, then your health insurance company will not bear your medical expenses. 

Similarly, your health insurance company may not provide cover for an injury caused due to adventure sports like paragliding, scuba diving, base jumping, rock climbing, skydiving and river rafting.

Pre existing injury and disease are not covered under health insurance

If you have suffered an injury or have any kind of disability before taking a health insurance policy, you can’t file a claim for the treatment. However, some pre-existing diseases are covered by almost all health insurance companies on regular premium payment for 2 to 5 years. Pre-existing injury is also not covered under myUpchar Insurance Plus policy. 

myUpchar Insurance Plus generally does not cover situations that other companies do not cover. You cannot claim under My Treatment Insurance Plus in the following situations.

  • Expenses for the treatment of diseases caused by the use, addiction or abuse of alcohol and other intoxicants. (Read more: Alcoholism)
  • Any treatment or medical expenses, other than accidents, incurred within the initial 30 days of the policy term.
  • Medical expenses for the treatment of congenital diseases.
  • Medical expenses for self-injury, suicide, or attempted suicide.
  • Medical expenses incurred on abortion or miscarriage. 

There are many other situations in which health insurance companies do not pay claims. Some of these include 

  • Resident Doctor's fees, out-of-country treatment and air ambulances. But nowadays health insurance companies are coming up with policies that cover air ambulance and treatment abroad. 
  • Expenses incurred during hospital admission and discharge (apart from the treatment) 
  • Wheelchair, walker, crutches or any other medical equipment that you may need.

Disclaimer: The above list is not exhaustive. Your policy may not cover several other diseases. On the other hand, some of the abovementioned things can be added to a health policy by paying an extra premium. Insurance companies also sell policies separately for many specific situations. So ask your health insurance company about this in detail and read the policy wording carefully. 

cross
Ask your health query now and get connected with a doctor within 10 minutes!