Health Insurance Inclusions & Exclusion

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Inclusions & Exclusion In Your Health Insurance Policy

16th November 2022 8min read 105 views

When the COVID-19 pandemic broke out in 2020, people started learning as much as they could about health insurance. Everybody wanted to purchase a health policy to help deal with the high costs of a medical emergency. Although people have become more aware of the importance of having health insurance, they sometimes forget to read the fine print. Health plans have various inclusions and exclusions. If you try raising a claim for an exclusion, your request gets rejected. To avoid such situations, you must learn what your policy covers and what it doesn’t.

Health Insurance Inclusions

Let’s first look at the coverage offered by almost all types of health insurance plans:

In-patient hospitalisation

Your treatment gets covered if you’re hospitalised for more than 24 hours to receive treatment. Health insurance plans will help you pay the daily room rent, doctor’s fee, ICU charges and more.

Pre- and post-hospitalisation expenses

Your health insurance policy will help with related expenses in the days leading to hospitalisation and those immediately following it. Most companies cover costs between 30 to 60 days pre-hospitalisation and 60 to 90 days post-hospitalisation.

Daycare Treatment

Most health insurance plans available today also cover the cost of daycare treatment or outpatient procedures. Covered treatments include cataract surgery, dialysis and more. Your insurance company will have a list of outpatient procedures they cover.

AYUSH

People have preferences regarding their treatment. Many prefer Ayurveda or Homoeopathy to allopathy. Various types of health insurance policies available today offer coverage for AYUSH or Ayurveda, Yoga and naturopathy, Unani, Siddha and Homoeopathy treatments.

Health Insurance Exclusions

Unfortunately, there will be some limitations on your health insurance coverage. Let's look at the exclusions.

Pre-existing Illnesses

You must declare all existing health conditions while purchasing a policy. Health insurance companies do not cover any treatment costs related to the pre-existing disease for at least two years from the date of purchase. After years of continuous coverage, they may start covering some costs. There will be a pre-existing disease waiting period stipulated on your policy documents.

Diagnostic Charges

Health insurance companies often do not cover the cost of diagnostic tests. You will have to pay for tests related to diagnosing your health issue from your pocket.

Cosmetic Surgery

Health policies do not cover elective cosmetic procedures. Procedures such as Botox, facelifts, augmentations and rhinoplasty get excluded from insurance policies.

Specific Diseases

Every insurance company will provide a list of illnesses they do not cover. Joint disorders, hernias, and sexually-transmitted diseases are often not covered, and you cannot file valid claims for them.

Self-Inflicted Injuries

Individuals who self-harm or get hurt while attempting suicide will not get insurance coverage. Every claim request gets investigated. The insurance company will not accept any claims that arise from self-inflicted injuries or suicide attempts.

Illegal Acts

Health policies also exclude injuries caused by the policyholder’s misuse of alcohol or drugs or during any attempt at an illegal activity.


Understanding the inclusions and exclusions of your health plan enables you to make informed decisions about raising claims. Before you buy health insurance online, take a minute to view each insurance company’s inclusions and exclusions. Looks for plans that offer the highest coverage at pocket-friendly prices. After purchasing Mediclaim, you should renew your medical insurance policy every year. On-time renewals ensure you always enjoy the required cover.

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