Understanding Policy Clauses In Health Insurance

The clauses that are related to limitations and exclusions may seem complicated at first but it is crucial to understand these before signing up. There could be some exclusions and limitations that may not affect you or your family at all while some may be important depending on your health history and hereditary family history. So while what is excluded for one person may not make a difference, it might make a huge impact for another. That is why it is important to understand what these are and how they impact and relate to you as an individual and to your family in general.

Exclusions are those conditions or expenses that are not covered by the insurance company. In such cases, the claimant will have to share a pre-specified portion of the expenses in the claim if it should ever arise. Some insurance companies will also impose a sub limit that is within the sum insured overall. Exclusions are those expenses that the insurance company need not pay for. The IRDA has standardized this with a list of expenses. There are also different waiting periods for different conditions.

One of the common exclusions for health insurance are pre-existing diseases. This is because the entire premise of insurance is based on uncertainty so if there is a disease that you are already suffering from, it will not come under the insurance. Usually, you can get insurance companies to cover you for a pre-existing disease after a specified waiting period is over.

Another thing that is excluded is pregnancy and expenses related to childbirth and later vaccinations. There could be a waiting period for pregnancy as well, after which there are some benefits that could be availed. 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 which should be carefully looked into at the outset before investing in an insurance policy. A sub-limit is related to exclusions that are associated with doctors’ fees, ambulance costs, rent for hospital rooms, etc. Knowing your sub limits keeps you prepared in case of an emergency so you know exactly what will be covered and what you will have to pay for out of your own pocket.

There are policies which seem to have a whole list of exclusions and sub-limits and there are those that have a moderate amount of them. So knowing what is excluded and what is not will help you make a better decision regarding which health insurance to choose. This can be done easily by doing a systematic and meticulous comparison of health insurance policies taken from different websites or from the agents directly. Knowledge is power and knowing this beforehand helps you in better planning your future and that of your family.

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