Exclusions in a Health Insurance

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Health Insurance
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Exclusions in a Health Insurance What does a
health insurance not cover i.e. exclude? The
moment of truth in an health insurance is at the
time when a claim arises. One of the most common
reasons for a health insurance claim not being
paid by an insurance company is when they say
that the particular disease is not covered by the
policy and is exclusion".
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It leaves a bitter taste in the mouth of the
policy holder and can sometimes put the policy
holder in great financial difficulty. Thus, it is
very important to know in detail about the
exclusions in a health insurance before
purchasing it. In our opinion, it is a far more
important variable than price. A policy might be
10 cheaper than a competitor's policy but might
have many more exclusion clauses-in such a case,
the policy with the lesser number of exclusion
clauses would be the better choice for the policy
holder.
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In this article, we deal with some of the common
exclusion clauses in a health insurance. Of late,
we are seeing some innovation in this area with
the new companies not excluding certain ailments
which had traditionally been within the
exclusions area
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Maternity In most cases, maternity and maternity
related expenses are not covered in an individual
or family floater health insurance. Maternity is
typically covered in a group policy. In certain
cases, we are seeing maternity being covered
after 5 years into the policy. Diseases or
illness contracted within the first 30 days of
the policy. The insurance company does this to
safeguard itself against customers buying a
policy immediately after a disease has been
detected
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Cataract, Prostrate, Hernia, Piles, fistula,
gout, rheumatism, kidney stones, tonsils and
sinus related disorders, congenital disorders,
drug addictions, non allopathic/alternate
treatments, self-inflicted injuries,
hysterectomy, fertility related treatments, etc.
are normally not covered under a health insurance
policy. Dental treatment and cosmetic surgery is
also typically excluded. Contact lenses cost is
also not covered. HIV/AIDS is excluded, which has
been a subject of great debate and criticism in
the last few weeks. Some insurance companies do
not cover treatment incurred outside the country,
so you should check once before buying the policy
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Preexisting diseases are not covered in a health
insurance policy. Preexisting means a disease
that you have had prior to joining a health
insurance policy. The policyholder may or may not
have been aware of the pre-existing disease.
Further complications which arise due to the
preexisting disease are also not covered. For
example, renal problems which arise due to a
person having diabetes at the start of the policy
would not be covered. This can sometimes lead to
a lot of confusion and heartburn.
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Someone gets admitted for a kidney related
treatment, and the insurance company turns down
the claim saying the kidney problem has arisen
because the patient had diabetes, and rejects the
claim. It can get a little grey here as medical
science cannot sometimes clearly pinpoint the
root cause of a particular disease outbreak. In
most cases, preexisting diseases are covered
after 3 or 4 consecutive policy years. This is
the single biggest reason why one should buy a
health insurance at a young age, and continue
with the same insurer.
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Because if you shift to a new insurer, you lose
your previous credit and a disease that was being
covered by the old insurer might be treated as a
pre-existing disease by the new insurer. We have
noticed that insurance companies start facing
more claims from the health insurance customers
from their 4th or 5th policy year, as preexisting
begins to get covered and the profitability of
the portfolio goes down
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Most policies do not cover day care, but a few
like Max Bupa cover daycare, although the premium
is higher in this case War related health
insurance claims are mostly excluded from the
policy coverage Abortion related health expenses
are not covered in a health insurance
policy Please do note that with competition
heating up, some of the exclusions mentioned
above will begin to get covered by a company or
two so that it can be used as a selling point.
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Thus, the lists mentioned above are subject to
change. The moot point here is that 10 minutes
spent to read the exclusions list of the health
insurance you are considering to buy could save
you a lot of headache buyer. Be an informed
buyer- there will be no else to blame but
yourself. Source http//ezinearticles.com/?Exclus
ions-in-a-Health-Insurance-Policyid6323370
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