What does a health insurance
policy not cover i.e exclude?
The moment of truth in an
insurance policy 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
an "exclusion". It leaves a bitter taste in the mouth of the
policyholder and can sometimes put the policyholder in great financial
difficulty. Thus, it is very important to know in detail about the exclusions
in a health insurance policy 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 policyholder.
In this article, we deal with
some of the common exclusion clauses in Health
insurance policies. 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
Maternity: In most cases,
maternity and maternity related expenses are not covered in an individual or
family floater health insurance policy. 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
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
Pre existing diseases are not
covered in Health insurance policies.
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. 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
policy at a young age, and continue with the same insurer. 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 pre
existing begins to get covered and the profitability of the portfolio goes down
War related health insurance
claims are mostly excluded from the policy coverage
Abortion related health expenses
are not covered in Health
insurance policies
Pl 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. 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 policy 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.
Article Source:
http://EzineArticles.com/6323370
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Medical health care Tampa