Excuse Me Please: Standard Exclusions In A Health Insurance Policy

The exclusions of a health insurance policy differ from one insurance provider to the next. Here is a list of the standard exclusions in a health insurance policy

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Health insurance does a great job of protecting you from the escalating cost of healthcare today. However, health insurance has its limitations too! There are certain circumstances that are not covered by most health insurance policies — they are known as exclusions. This article will go over some of these exclusions to help you better understand the coverage of your health insurance policy.

Pre-existing conditions

Generally speaking, health insurance plans do not provide cover for ailments that you have while buying the policy. There will be a waiting period before such conditions are covered by the plan. Alternately, some insurance companies will charge higher premiums to cover such ailments.

Conditions that arise from substance abuse

Most health insurance plans will not cover illnesses that are induced by substance abuse. You will have to pay the bills on your own if it is found that your condition is caused due to excessive smoking and/or drinking. Your claim might also be rejected if it is found that you’ve hidden information related to such a habit from the insurance company.


Medical expenses arising due to self-harm are usually excluded from the coverage of a health insurance policy. This also applies to hospitalization arising from an attempt to commit suicide.

Cosmetic procedures

Cosmetic procedures that are deemed ‘unnecessary’ are generally excluded from the coverage of a health insurance policy. This means that individuals opting for plastic surgery to enhance their appearance might not get compensation from their insurance policy. However, if the procedure is deemed ‘medically necessary’ as in the case of bariatric procedures for obese individuals and coverage for the said cover is available in the policy then the health insurance policy may provide compensation for the procedure.

Medical expenses in the initial 30 to 90 of plan coverage

All health insurance policies have a general waiting period that kicks in the moment you buy the policy. This waiting period usually lasts between 30 and 90 days. During this waiting period, no medical expenses will be covered by the policy. The only exception being medical expenses/hospitalisation due to an accident.

The exclusion list may differ from one insurance company to the other. Therefore, before you buy a policy, remember to cross-check the exclusions thoroughly. If you even have a moment of doubt regarding the coverage of the policy, get it cleared out before moving forward.

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