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Inclusions and exclusions in your health insurance policy

With the rising number of diseases and healthcare costs, it is important to understand the inclusions and exclusions of your health insurance plan.

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4 mins 25 secs
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Last Updated - September 6, 2023
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Life is very uncertain and having a health insurance policy for you and your family should be the utmost priority. With the rising number of diseases and healthcare costs, it is important to understand the inclusions and exclusions of your health insurance plan. Health insurance plans usually cover all your medical expenses and hospitalization but there are a few exceptions that are not covered by the insurer. 

The inclusions and exclusions of your health insurance plan may vary from company to company. Know more about the various inclusions and exclusions in your health insurance plan so that you can take an informed decision while buying a health insurance plan.

Exclusions in health insurance plans:

  • Pre-existing disease
  • Cosmetic surgery
  • Dental and Hearing
  • Self-inflicted injury or Suicide Attempt
  • Specific diseases
  • Diagnostics Charges

Exclusions are medical expenses or healthcare treatments that are not covered by your health insurance provider. There are some exclusions that are not covered and so the insurer does not pay the claims made for such exclusions.
Here is a list of common exclusions that you will come across in a health insurance plan:

Pre-existing disease

If you are having any medical condition before purchasing a health insurance plan, then it wouldn’t be covered under the policy for a particular period. This condition is usually preferred as pre-existing disease and comes with a waiting period. The waiting period for various medical conditions differs from insurer to insurer. 

Cosmetic surgery

Any treatment for the beautification of looks, hygiene-related treatments, and surgeries such as lip augmentations, rhinoplasty, botox, facelifts, implants, and more are excluded from your health insurance plan. Health insurers won’t provide cover for treatment of any such services.

Dental and Hearing

Both dental and vision treatment is short-term procedures and mostly do not require hospitalization. For that purpose, they are excluded by the majority of health insurers. However, there are a few insurance plans that cover these expenses up to a limit depending on the Sum Insured.

Self-inflicted injury or Suicide Attempt

In a situation, where a policyholder is intentionally doing self-injury or attempting suicide, the claims will be rejected. Injury or illness due to the use, or misuse of intoxicating drugs or alcohol is also excluded from a health insurance policy.

Specific diseases

When buying a health insurance policy, if you have a specific disease such as a joint disorder, hernia, or sexually transmitted disease then they are not considered to be processed under the claims.

Diagnostics Charges

When you undergo tests and diagnosis of various treatments, the charges levied by the clinic are usually not covered under the health insurance plans.  

Inclusions in a health insurance plan:

  • In-patient Hospitalization
  • Pre & Post Hospitalization
  • Annual health checkups
  • No Claim Bonus (NCB)
  • Day care treatment

In-patient Hospitalization

Now you don’t need hard cash to start your treatment and hospitalization. You can avail of In-Patient hospitalization. Expenses such as room charges, nursing expenses, ICU, Doctor’s fees, and more are included in your health insurance plan. 

Pre & Post Hospitalization

All the pre and post-expenses such as medical expenses, doctor’s fees, treatment, follow-ups, and more are covered under your health insurance plan.

Annual health checkups

Every health insurance plan provides annual checkups to the policyholder. Annual checkups include tests for blood sugar, kidney function, ECG check-ups, and more. All the insured members under the policy can avail of annual health check-ups once a year.

No Claim Bonus (NCB)

No Claim Bonus (NCB) is a reward that a health insurer provides to the policyholder for a claim-free year. The bonus amount gets accumulated to the sum insured for every claim-free year. Know more about No claim bonus.

Day care treatment

Daycare treatments are treatments that do not require hospitalization for 24 hours. The treatments cover cataract surgery, chemotherapy, dialysis, and more such operational services.


Health insurance is the need of the hour and having appropriate coverage is equally important. One must definitely check on all the inclusions and exclusions of your health insurance provider. Get a large cover for your family and stay stressed-free.

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Sachin Telawane is a Content Manager and writes on various aspects of the Insurance industry. His enlightening insights on the insurance industry has guided the readers to make informed decisions in the course of purchasing insurance plans.