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Exclusions in health insurance often cause conflicts

Not all treatments are payable by insurance companies under a health insurance policy.

Not all people are fully aware of these exceptions, which in insurance parlance are called "exclusions".

This lack of awareness and communication routinely results in disputes and disagreements with the insurance company.

Listed below are the most common exclusions you will often find as part of any typical health insurance plan.

1. Amount spent on treatment of pre-existing diseases / conditions / ailments / injuries, including any complications arising from them, will not be payable. It does not matter whether you were aware of such problems or not. Such medical issues normally get covered only after 48 months (i.e. 4 years) of continuous coverage under the health insurance policy.

2. Any illness or disease, that is contracted during the first 30 days from the date the insurance policy becomes effective, is excluded. However, medical expenses that arise out of an accident would be covered during these first 30 days.

3. There is a waiting period — typically around 12 to 24 months — during which certain specified diseases will not be covered. Some such common exclusions include cataract, piles, hernia, tonsils, hypertension, diabetes, benign ENT disorders, etc.

4. There is a  waiting period — typically around 48 months — during which certain age-related medical problems will not be covered. Some such common exclusions include osteoporosis, knee replacement, arthritis, etc.

5. Corrective or cosmetic dental surgery, filling of cavity, root canal treatment, etc. are all excluded from a typical health insurance plan. However, dental problems that become necessary due to any accident, are payable under the policy.

6. Surgery for correction of eye sight, cost of spectacles and contact lenses, hearing aids.

7. Treatments related to pregnancy, childbirth, miscarriage, abortion and caesarean section.

8. Diagnostic charges e.g. laboratory examinations, x-ray etc. which are not related to any specific illness, injury etc. that require hospitalization.

9. Psychiatric and psychosomatic disorders.

10. Alternative therapies such as naturopathy, acupressure, acupuncture, etc. 

11. Genetic disorders, stem cell implantation / surgery.

12. Treatment of obesity, weight control program, Cosmetic and Plastic surgery e.g. botox, liposuction.

13. Circumcision, Infertility, Sterility, Venereal diseases, sexually transmitted diseases, including HIV AIDS.

14. Vitamins, tonics, vaccination and inoculation.

15. Any injury or disease that is a result of any war, invasion, nuclear weapons/materials or problems arising out of misuse of liquor, drugs etc.

Medical problems are anyway a difficult and challenging experience physically, mentally and emotionally. There is no point in adding disappointment and bitterness to it. Besides, you can plan the cost of treatments more judiciously and minimize the financial setbacks. So read the terms and conditions of your health insurance policy... now.

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