Have you ever experienced having a health insurance policy and not processing your claim? The usual exclusions or waiting periods outlined in the insurance may cause the claim to be denied in some circumstances. Therefore, it is recommended to choose “what is not included in the coverage of the policy” instead of “what is included as coverage by the policy.”

Let’s Examine Some Critical Aspects Regarding Typical Exclusions In Health Insurance Policies:

• 30-Day Initial Waiting Period

The policy has a 30-day introductory waiting period in health insurance. This means that after purchasing coverage, you must wait one month before filing a claim.

30-day waiting time      : All expenses      from accidents are covered, except expenses linked to treating any disease within 30 days of the first policy commencement date are excluded. ^

Particular Illnesses (2 Years)*

The policy paper lists a few specific ailments covered after two years and noted in the text.

These are the costs (Excl02) for treating these conditions, including surgeries and procedures not covered for 24 consecutive months from the policy’s start date. 

Claims that arise from accidents are not subject to this restriction.

Even if it is negotiated post the policy’s effective date or proclaimed and accepted without an explicit exclusion, the waiting time for the listed conditions shall apply.

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Below are a few of the conditions that are specified in a health insurance policy:*

• Gastrointestinal Ulcers Of Any Kind
• Cataract
• A Fistula Of Any Kind 
• Degeneration Of The Macula
• Prostatic Hypertrophy That Is Benign
• Hernias Of Every Kind
• Each Variety Of Sinuses 
• Crack In Ano
• Heaps, Haemorrhoids 
• Hydrocele 
• Irregular Uterine Bleeding 
• Fibromyoma 
• Endometriosis 
• Hysterectomy 
• Abdominal Prolapse 1

• Biliary And Urinary System Stones 
• Ear, Tonsil, Adenoid, And Paranasal Sinus Surgery 
• Any Type Of Internal Or External Tumour, Cyst, Nodule, Or Polyp, Including Breast Lumps, Requires Surgery. 
• Mental Health 
• Illnesses Affecting The Gallbladder, Such As Cholecystitis
• Pancreatitis 
• Cirrhosis In All Its Forms 
• Gout And Arthritis 
• Tonsilitis 
• Varicose Vein And Varicose Ulcer Surgery 
• Persistent Kidney Disease 
• Alzheimer’s Condition

Previously Diagnosed Illnesses – 4 Years

However, let’s examine this in greater detail using the language used in the typical exclusions in health insurance clauses.

Any illness, injury, or disease diagnosed by a doctor within 48 months of the policy’s effective date or reinstatement is considered a pre-existing condition. 

In simple terms, if you’re on medication or have a condition diagnosed 48 months before getting health insurance, it’s considered a “Pre-existing disease,” and claims related to it are paid after four years.

^     Claims are subject to terms and conditions set forth under general health insurance policy     .

*Standard T&C Apply

# Visit the official website of IRDAI for further details.

Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms, and conditions, please read the sales brochure/policy wording carefully before concluding a sale.