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Monday, December 19, 2016

Top 10 common exclusions in health insurance policies

Often I hear from family and friends that '#health insurances plans are bad, as they don't pay'. It gets very difficult to reason with them as they themselves have gone through some bad experiences on claim settlement under #health insurance policies.

With growing healthcare cost, #Health insurance has become unavoidable part of financial planning. It helps us plan for unforseen medical emergencies. Not only financially, health covers acts as an emotional support system. So, it is prudent to check few medical insurance options before finalising a health cover which suits your needs and fits well with medical history of the family. All health insurance products have different sets of offerings, sub-limits and exclusion clause. Here, in this article my idea is to share some of these common exclusions in the health insurance policies.
When you decide to buy a health cover, it is an agreemeent you are about to sign based on mutual trust, that you are disclosing correct information about yourself for an agreed premium, and in return, the insurance company is bound to help you with financial support based on agreed terms and conditions. You may take the cover from private health insurer or public insurer. Check the contract twice or more to confirm on all the details.

Top 10 common exclusions in health insurance policies

1. Complete exclusion on diseases - There are certian diseases which are permanently excluded from the lists. Diseases which are sexually transmitted like HIV infection or AIDS, and others. Diseases caused by alcoholism, drug abuse etc. This is applicable for individual insurance as well as group health policies

2. Pre-existing conditions - Health Insurance companies have clause set for treatments on pre-existing diseases. It also dont cover pre-existing bodily injuries of accidents. It can very from 1-4 years depending on the insurance company and the particular policy in question.

3. Sub-limits on expense heads - Though the insurance company is liable to pay upto complete sum-assured of the insurance policy, certain expenses like room rent, doctor fee, medicine expenses may come with a cap of certain percentage of the sun assured. For example, if any policy has a cap of Rs. 2000 on room rent per day, and the actual rent paid is 4000, the policy holder has to cough up the extra Rs. 2000, even if the total treatment cost is below the sun assured.

4. Hiding medical/family medical history - this is considered to be breach of trust by the insurance company. If any existing disease or medical history undisclosed in the policy contract, insurance company has the authority to completely reject the claim settlement application.

5. Alternative treatments - ayurveda/homeopathy/Unani- Though IRDA is taking more inclusive approach towards the alternative based on growing demand on Homeopathy, ayurveda etc, still many insurance policies don't provide for it or come with cap on the expenditures.

6. Pregnancy and childbirth - Insurance as a financial product is designed for emergency/un-prepared events, pregnancy doesn't come under that. Hence, insurance policies don't cover pregnancy, miscarriages, child-birth untill otherwise specified. Few policies do cover this with a higher premium and a minimum waiting period of 2 years.

7. Cosmetic surgery - Any cosmetic corrective surgery etc is not covered by insurance companies.

8. Injuries during war, neuclear radiation - The insurance company protects itself againstassive losses arising from major threatening situations like war/ public agitation related injuries etc.

9. Treatment for weightloss/gain, and other corrective dental or eye surgeries - surgery or treatment related to weight loss is gaibs are excluded for  the list. Any corrective dental surgery or are surgery unless from accidental injuries are not covered under health insurance.

10. Injuries related to proffesional or hazardous sports - injuries caused in proffesional sports are not excluded from the cover.

Depending on your comfort-level you may buy online health plan or opt to call your financial advisor.

#Health insurance being one of the top three priorities in #financial planning, it deserves a certain amount of attention from the policy holders more than just financial security.
#health insurance #financial planning 

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