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What Does Your Family Health Insurance NOT Cover?

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Health insurance document

While more than 80% of the urban and rural population is not even insured, a major percentage of the rest are unaware of the fineprint of a policy.

Source: Wikimedia


If you are buying a family insurance for your family, have you read the fine print properly? Or have you compared the various plans properly?  If you just shook your head for a “NO,” you might also land into a trouble. Comparison and research will give you a fair idea of benefits offered by various plans available. Like you don’t buy a car without overanalyzing, don’t buy health insurance before you do your homework.

If you think just getting a family health insurance is end of discussion and it will cover all your family health cost, you are wrong. There are exclusions. Wondering how they matter?

Policy Exclusions: What doesn’t your policy cover?

 Making the right choice of health insurance plan is equally important as having the plan itself. If the plan you have just purchased is not helpful in the event of an emergency, then it is a complete waste of money. If you rush towards buying an insurance plan overlooking the exclusions, then you won’t be covered for these conditions.

Let’s see what does your family health insurance NOT cover.

Pre-Existing Conditions

If any of the family members are suffering from excluded diseases at the time of taking the policy, then it will be counted as a pre-existing condition. And it will not be covered as insurance is meant to cover uncertainties. There may be a waiting period of a few years before you may get cover for these diseases. Some pre-existing diseases are cataract, kidney, stones, arthritis, chronic diseases, and other lethal diseases.

Maternity Expenses

There are many policies which don’t cover pregnancy, childbirth, and the costs of vaccination. There may be a waiting period of 1-2 years. Once the waiting period is over, then you get the complete benefit of the policy.

Certain Surgeries

Many surgeries may not be covered in the policy at all. Some examples of these surgeries are joint replacement, cosmetic surgery, dental surgeries etc. These and others like them may not get covered in your family health insurance policy.  So if you are planning to buy a policy to cover the expenses of expensive surgeries, then you should read the policy document carefully.

Treatment Other Than Allopathic

Almost every insurance policy provides cover for allopathic treatment. Homeopathy, Ayurveda are termed as alternative treatment procedures. They are on the exclusion list of many health insurance policies. However, some insurers do cover them too. Just make sure you have it as a question on your first meeting with the representative.

Costs of Hospital

Many hospital costs may be there in the restricted form.  So it is very much possible that there are sub-limits on the hospital that you may occupy in terms of the fees of the doctor, cost of the ambulance and other such things. You should read the policy document or ask the agent clearly about the exclusions that may be there. It will help you a lot in the event of any emergency.

Birth Disorders

If any of your family members is suffering from any disorder right from the birth, then your policy may not offer any coverage for these disorders.

Minor Illnesses

Your policy might not be covering the costs of minor illnesses which don’t require hospitalization. In fact, almost all policies offer coverage if the illnesses require coverage of more than 24-hours in the hospital.

Eyeglasses for Kids

If your kid develops a myopic or hypermetropic condition which requires going for vision treatment and needs your kids to wear sunglasses, then the cost of these sunglasses might not be covered by your family health insurance policy.

Weight Loss Surgeries

If any of your family members are obese and you join a weight management program to reduce the same, then the incurred costs may not be covered by the insurance policy. Similarly, if you go for any weight loss surgery, then it may not get covered in your policy.

Choosing a family health insurance

With the swarming number of health plans available today, it becomes extremely difficult to zero down on one insurance plan. Here’s your visual guide to choosing a family health insurance plan.

Image Source :
Apollo Munich Insurance

Finally, Insure Early To Get Covered

Now it is clear there are certain conditions for which there will be no coverage. But if you have certain pre-existing conditions, it is advisable that you go for family health insurance early so that the waiting period of the policy is over before you are hospitalized. And while going for family health plan, just see that it provides cashless hospitalization, and also look for a higher claim settlement ratio.

Also Read: Life Insurance- Going Beyond after-life Investment

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