All the Health Insurance policies come with a long list of exclusions. They either exclude specific form of treatment, time-related restrictions, etc. No Health Insurance policy will cover every medical condition even if you are choosing the most expensive policy. Before taking a Health Insurance policy you must understand its limitations so that you aren’t caught off guard during an emergency. There are plans that you can buy to protect yourself against critical illnesses which may be excluded from the typical Health Insurance policy.
Following are the conditions that are excluded in a typical Health Insurance policy:
- When you are taking a Health Insurance policy you are asked to fill out a questionnaire about your medical history. If you miss out on mentioning any condition either on purpose or accidently, the insurance company can void any claims you make and exclude the benefits. If you get diagnosed with a condition shortly after taking a health insurance, the insurer will decide if it was a pre-existing illness and it will most likely be excluded. The pre-existing condition can be injuries relating to accidents which were treated for before taking the policy.
- Most insurers have time-related exclusions as well. The benefit for a certain condition will be covered after a certain time has been passed. For making a claim related to pregnancy, there is a waiting period of 12 months. This is done to prevent couple from buying a Health Insurance policy after finding out about pregnancy and to just to cover for the maternity cost. Dental benefits also have a waiting period of 6 months.
- Special charges when the insured is hospitalised is excluded. It can be exclusion on registration, nursing care, admission, lab tests, medical supplies, etc. If the insured is getting a surgery, the insurer will not cover operation theatre cost, nursing, anaesthetist cost, scans, specialist fees, surgeon fees and consultant fees. The insurers most often exclude telephone, internet, food, drinks and roll-in-bed fees.
- Treatment for plastic surgery, vision aids, hearing loss, infertility, drug abuse, impotence and skin disorders are excluded.
- Certain hospitals and clinics are excluded from Health Insurance policy. The cheaper Health Insurance policies require you to go to clinics and not hospitals. So, when you are taking a Health Insurance policy make sure that the hospital you visit is included in the list and ensure that the hospital close to your home and workplace is included.
- Injury or sickness caused by self-destruction while sane or insane is excluded.
- Injury caused by war, riots, civil commotion, mutiny, hostilities, rebellion, terrorist activities, civil war, insurrection, revolutions and any warlike operations are excluded.
- Injury causing due to Naval or Military service at the time of declared or undeclared war is excluded.
- Professional sport injuries are excluded. This includes aerial flight, hand gliding, ballooning, bungee jumping, parachuting, winter sports, powerboat racing, water ski jumping, skin diving, ice hockey, hunting on horseback, polo, horse racing, show jumping, rock climbing, potholing, mountaineering, riding or driving in any kind of race, rally or completion, boxing, judo, wrestling, karate and any other kind of martial arts.
- Injury or condition arising out of contamination, pollution, radioactive source, military activities, nuclear fuels and scientific activities are excluded.
- Chronic conditions that has no known cure and which is recurring and if it leads to disability or causes changes to body that cannot be reverse, which requires rehabilitation, prolonged supervision, treatment including mental condition will be excluded. Condition that arise out of a non-existing pre-existing chronic condition that requires the insured to be hospitalised will be covered.
- Mental and nervous disorders, physiological illness and treatment, treatment for alcohol, drug or substance abuse will be excluded.
- Alzheimer’s, pulmonary tuberculosis, cosmetic surgery will be excluded.
- General check-ups will not be covered.
- Treatments in spas, nature care clinics, acupuncture, acupressure, Ayurveda, chiropractic, aromatherapy, etc. will be excluded.
- Overseas treatment outside the geographic limits set by the insurer will be excluded.
- Corrective eye surgeries are not covered.
- Cosmetic dental treatment are excluded.
- Corrective devices such as glasses, lenses, frames, hearing aids, walking aids, artificial limbs, braces, breast pumps, syringes, slings, nebulizers, air chambers, etc. will be excluded.
- Diseases that are sexually transmitted, syphilis, genital virus, gonorrhoea, sterility, fertility, etc. will not be covered.
- Preventive treatments are also excluded.
- Growth failure and growth hormone replacement therapy, menopause, hormone replacement therapy, allergen testing will not be covered.
- Donor transplant will not be covered.
- Pregnancy, childbirth, miscarriage will not be covered unless there is a maternity benefit coverage.
- Treatment for losing or gaining weight, anorexia, bulimia, etc. will be excluded.
- Transportation and hotel accommodation charges are excluded.
- Amount in excess of reasonable inpatient, admission, day care and procedure for treatment will be excluded.
- Tests or treatments to HIV, AIDs or similar conditions will be excluded.
- Payments for disability arising due to course of employment will be excluded.
- There is usually a waiting period for covering hernia, haemorrhoids, fissures, deviated septum, adenoids, tonsils, thyroids, varicose, hysterectomy, uterine fibroids, endometriosis, hydroceles, varicoceles, non-accident related knee or back surgery, non-accident related plastic surgery, surgery for correction of refractive errors, dental or gum surgery.
After going through the list above you might wonder why you even need a Health Insurance policy if there are so many conditions set and when there are so many exclusions. Even with the exclusions, at the end of the day you need a Health Insurance policy to protect yourself. Plus now it is compulsory for a UAE Resident to have a policy. Insurers just want to make profit and hence put so many exclusions. It is important that you compare the various Health Insurance in UAE before you choose a plan that best suits your needs. You can find a great plan for yourself and your loved ones despite the exclusions that come with the Health Insurance policy.