Insurance Expert - Answered on Jul 29, 2022
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Certain conditions are not covered by health insurance policies. These conditions will land in an ‘Exclusion' in your health insurance policy.
The exclusion list includes unless specifically mentioned in your policy document:
1. Pre-existing health conditions which are not declared from the time of policy inception
2. Lifestyle-related conditions
3. Maternity related complications, including treatments and childbirth, etc,
4. Cosmetic Treatments unless necessary for survival
5. Suicide Attempt Injuries
6. Congenital Diseases
7. War Injuries
8. Dental and eye expenses, unless specifically covered under OPD
9. Diagnostic tests without any proper line of treatment which needs hospitalisation
10. Therapies such as naturopathy, magnetic or acupressure, etc.
11. Waiting Period Illnesses
The insurance provider will not accept any claims in these instances. However, you can purchase add-on coverage to include any exclusion to your base coverage.
- Better Sum Insured Value
- Lowered Policy Premiums
- Get an insurer with a better Claim Settlement ratio
- Better service provider
- No Loss in previous policy benefit
I suggest you speak with your insurer on why only Rs 500,000 was settled against your bills.
Also as a rule, do read all the terms and conditions on your policy document and the claim settlement process followed by your insurer.