The clauses related to limitations and exclusions may seem complicated at first, but it is essential to understand them before registering. There may be some exclusions and limitations that may not apply to you or your family at all, while others may be important based on your medical history and hereditary family history. So while what is excluded for one person may not make a difference, it can have a big impact for another. That’s why it’s important to understand what they are and how they impact and relate to you as an individual and your family as a whole.
Those conditions or expenses that are not covered by the insurance company are excluded. In such cases, the claimant will have to share a pre-specified portion of the expenses in the claim if it ever arises. Some insurance companies will also impose a sub-limit that is within the overall sum insured. Exclusions are those expenses that the insurance company does not need to pay. The IRDA has standardized it with a list of expenses. There are also different waiting periods for different conditions.
One of the usual exclusions from health insurance are pre-existing conditions. This is because the entire premise of insurance is based on uncertainty, so if you are already suffering from a disease, it will not be covered by insurance. You can usually get coverage for a pre-existing condition from insurance companies after a specific waiting period has ended.
Another thing that is excluded is pregnancy and expenses related to childbirth and subsequent vaccinations. There could also be a waiting period for the pregnancy, after which some benefits could be reaped. Other things that are excluded from a health insurance policy are cosmetic surgeries, dental surgeries, alternative treatments such as Ayurveda and homeopathy, etc.
Sub-limits are another factor that should be carefully considered up front before investing in an insurance policy. A sub-limit relates to exclusions associated with physician fees, ambulance costs, hospital room rentals, etc. Knowing your sublimits keeps you prepared in case of an emergency so you know exactly what will be covered and what you will have to pay. you will have to pay out of your own pocket.
There are policies that seem to have a full list of exclusions and sub-limits and there are those that have a moderate number of them. So knowing what is excluded and what is not will help you make a better decision about what health insurance choose. This can be easily done by doing a systematic and meticulous comparison of health insurance policies taken from different websites or directly from the agents. Knowledge is power and knowing it in advance helps you better plan for yourself and your family’s future.
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