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What Does Health Insurance Not Cover?



In a bid to choose the 'perfect Health Insurance', many policyholders overlook the exclusions. It is, of course, essential to know the benefits offered by your Health Insurance Plans. But it is equally important to understand what gets covered under Health Insurance as it saves you from hassles at the time of raising the claim. Here is a quick look at the standard exclusions:


Pre-Existing Illnesses


Have you been suffering from diseases such as high blood pressure or diabetes even before applying for a Health Insurance Plan? The chances are that your insurance provider will not offer any coverage for expenses incurred to treat these diseases. Make sure to check if your Health Insurance has any waiting period after which you can make reimbursements for pre-existing illnesses.


Cosmetic surgery


Any procedure undertaken to enhance your appearance gets excluded from Health Insurance Plans. This is also true for any dental treatments undertaken to improve the aesthetics. However, if any cosmetic procedure is recommended because of an accident, your Health Insurance Policy offers coverage.


Pregnancy and abortion


Expenses incurred for pregnancy and abortion are not part of most Health Insurance Plans. Many insurers do not consider these as diseases requiring Health Insurance cover. While voluntary abortion does not get any coverage under Health Insurance, your Insurance provider may offer coverage for abortions undertaken for saving the mother's life.  


Similarly, infertility treatments get excluded from Health Insurance cover. Make sure to check with your Insurance company before you sign the dotted line.


Diagnostic expenses


If you need to undergo procedures such as MRI, X-ray, or USG or send your blood samples to the laboratory for tests of any health condition, your Health Insurance does not provide coverage for the same. However, if the same tests get conducted as part of your treatment plan when you are admitted to the hospital, you can raise a claim under your policy.


Health supplements


Health tonics and protein shakes are readily available in the market and bought by anyone without a doctor's prescription. If you are buying these supplements to prevent the occurrence of certain diseases, you cannot claim them under your Health Insurance Plan. On the other hand, if such supplements get prescribed by your doctor as part of your treatment plan when you are hospitalised, then you enjoy the coverages under the plan.


Illnesses related to hearing and vision


Most procedures for ears or eyes do not require hospitalisation. Hence, it is not uncommon for Health Insurance Plans to provide any coverage for the same. However, in the event of any hospitalisation, you can raise a claim under the plan.




Remember that no two Health Insurance Plans are the same. Knowing the exclusions of your Health Insurance is essential when buying offline or online so that you make an informed choice.




Health insurance: 8 times

Health insurance plans: 5 times

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ICICI Securities Ltd.( I-Sec). Registered office of I-Sec is at ICICI Securities Ltd. - ICICI Centre, H. T. Parekh Marg, Churchgate, Mumbai - 400020, India, Tel No : 022 - 2288 2460, 022 - 2288 2470. I-Sec acts as a Composite Corporate agent having registration number –CA0113. Please note, Insurance related services are not Exchange traded products and I-Sec is acting as a corporate agent to solicit these products. All disputes with respect to the distribution activity, would not have access to Exchange investor redressal forum or Arbitration mechanism. The contents herein above shall not be considered as an invitation or persuasion to trade or invest.  I-Sec and affiliates accept no liabilities for any loss or damage of any kind arising out of any actions taken in reliance thereon. Investments in securities market are subject to market risks, read all the related documents carefully before investing.


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