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What May Not Be Covered In Your Mediclaim Policy?


Health insurance company is not liable to make any payment in respect of excluded illnesses as stated in your policy.Though exclusions can change from policy to policy,some of the common things may be as follows.Policy holders needs to confirm it from your advisor / company.

  1. Any diesease contracted by the person within 30 days from commencement of policy.This condition may not be valid for renewal cases or if policy holder is covered continuously by another health insurance plan for period of  at least 12 Months.(Check this condition with your advisor).
  2. All Pre-existing dieseases: Existing dieseases and suffered by the insured persons for which treatment was advised or received during preceding 48 Months from date of proposal.Pre-existing illnesses are either not covered or co-pay may be higher if covered.
  3. Some of the illnesses (Non-pre-existing)are not covered within first year of policy.E.g:Prostate Hypertrophy,hernia,sinusitis and related disorders.Details may be available in your policy documents.
  4. Some of the illnesses/procedures are not covered within first 2 years of policy.E.g.Knee replacement,joint replacement surgery as it can not be developed with immediate basis unless it is accidental.
  5. Pre-hospitalisation expenses are not covered.
  6. Injury caused due to war or warlike situation,act of foreign enemy will not be covered.
  7. Expenses arised,directly or indirectly  due to AIDS are not covered.
  8. Rehabilitation charges  (E.g.Physiotherapy,massage oil etc)  are not payable.
  9. Cost of contact lenses,spectacles,walkers,crutches or any other similar aids is not covered.
  10. Illness caused due to consumption of tobacco,drugs,alcohol and exposure to nuclear weapons are not covered.
  11. Expenses of Naturopathy treatment are excluded.
  12. Expenses related to purely cosmetic surgeries, weight loss/gain surgery may not be covered under mediclaim policies.
  13. Hospital registration charges, service charge,telephone charges are excluded.
  14. Policy holders should be aware of Co-pay related terms i.e.part of burden beared by him as per policy.
As already stated that,exclusions can change from policy to policy,insured person should know all about his medical coverage.So do not forget to check it from your policy document,advisor or insurance company.

Category: Insurance

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