What is Not Covered in Health Insurance?

Navigating through health insurance is a very tedious task. The growing importance of Health insurance, specifically in the times of COVID-19, is incomparable. People do not know how to fight this, and to protect themselves from this uncertainty, humans are increasingly thinking of health insurance policies without putting a hole in their pockets. The consumers do not have any say as to what all the insurance policies cover. It all depends on the insurance companies and their terms and conditions. Every policy has its requirements, and there are many things that are not covered in health insurance. In such cases, people should know when they will be able to claim the amount and when they won’t be able to do so.

Health insurance policies include various surgical and medical cases, but not all of them. Medical Health Exclusions are the cases or the situations in which the people are denied the claims. Although health insurance typically covers every doctor and hospital visit, prescribed drugs, wellness care, and medical devices, there are various other things that they do not include.

Let’s look at the cases where this unfortunate situation applies.



What is Not Covered in Health Insurance?

There are still many procedures that are not covered in health insurance and the consumers have to bear their expenses by themselves. Each benefit plan differs, and every plan does not cover every ailment, the insurance policies do not cover some of the medical procedures. They are:-


#1: Cosmetic Surgeries

Various treatments enhance people’s exterior beauty, like botox, plastic surgeries, and other cosmetic surgeries. Along with this, the dermatological procedures are also not included in health insurance policies.

Also read: How are Health insurance premiums calculated?

The whole insurance policy concept is to support emergencies on which humans do not have any control. It is the choice of humans to get cosmetic surgeries done and are not a necessity. Thus, in such cases, the insurance companies deny coverage, and the people have to bear the expenses all by themselves.


#2: Fertility Treatments

Although the clauses related to this treatment differ from state to state and company to company, the general procedure is that the health insurance does not cover fertility treatments. But, the companies have to provide support during the diagnosis of infertility, making it a case-to-case basis. There is no particular precedent for such treatments.


#3: Pre-Existing Diseases

Again a clause that differs from company to company is the coverage for pre-existing. Many insurance providers do not include high blood pressure, or diabetes or hereditary conditions.

There are high chances of policyholder suffering from pre-existing diseases. In such cases, the premiums are very high, only if the company provides coverage in these medical emergencies.


#4: Pregnancy and Abortion

The medical expenses for pregnancy and abortions are not covered in health insurance policies. Even in the case of a cesarean or a complication during the pregnancy, there is no coverage. The insurance companies do not consider pregnancy to be a situation in which one requires financial support.

Also, during the abortion, the companies do not provide the claims. But in a case where it is necessary to abort the child due to medical complications, the policy decision maker evaluates the situation to derive to a result.

Also read: Difference Between Critical Illness Insurance and Health Insurance

But voluntary abortion is not a part of the medical coverage.


#5: Diagnostic Expenses

The expenses incurred during the diagnosis of a disease are not a part of the coverage. The blood tests or the identification of a virus in a pathological lab are not a part of the coverage of health insurance. No matter if a hospital or a nursing home go through with these tests, they are not a part of the coverage of health insurance, and the patients cannot claim the money based on these.


#6: Miscellaneous charges

The health insurance companies provide coverage to the diseases only. The miscellaneous charges like the registrations, admission fee, service charges are also not a part of the coverage of health insurance.


#7: Health Supplements

The insurance company provider does not cover the expenses incurred during the consumption of health supplements. Health tonics and protein shakes are not a necessity for the body and are not an illness. Thus, the expenses related to these medical supplements are not a part of the coverage of health insurance. But if the same is advised by the doctor during the treatment of a particular ailment, while the patient is hospitalized, then these health supplements are a part of health insurance.


#8: Self-Inflicted Injuries

The expenses incurred if the patients have self-inflicted injuries, then it is not covered by health insurance. The concept of health insurance is all about providing financial support to people in case of unforeseen injuries and ailments. Self-inflicting injuries are not a sudden injury. Hence, they are not a part of health insurance coverage.


#9: Congenital Diseases

Many people are born with some defects in their bodies. Health insurance does not cover and provides support in such cases. People born with these cases have to support themselves, as the insurance companies do not take up the responsibility in such cases.


#10: Substance Abuse

Injuries incurred due to substance abuse or overdose of drugs and alcohol are not a part of the coverage of health insurance policies. The insurance companies do not provide support in such cases. The people have to bear these expenses all by themselves.




In Conclusion, health insurance policies cover many ailments and diseases. Still, there are certain situations and circumstances in which the companies do not help the patients. Thus, if one depends a lot on these insurance policies, they should keep in mind the cases in which they won’t be able to claim the health insurance. Various terms and conditions are an important part that one should consider while opting for health insurance. And everybody should keep in mind the injuries or circumstances which are not covered by health insurance policies.

This information helps the people in better financial planning, and they are not left stranded in times of need. Thus, make sure that you are fully aware of what type of contract you are getting into.

We hope this article was helpful and informative. And if you have any doubts and suggestions, then please contact us through the comments section.