Your health insurance protects you from most medical expenses - but not all of them.
Every policy includes exclusions - treatments, conditions, or expenses that are not covered.
Understanding these upfront helps you avoid unpleasant claim surprises later.
Some exclusions are temporary (like waiting periods), while others are permanent.
At PolicyBachat, we help customers in Hyderabad, Telangana understand these exclusions clearly and pick plans that minimize uncovered risks through riders or upgrades.
Here’s a full breakdown of health insurance exclusions, what they mean, and how to plan smartly around them in 2025.
Types Of Exclusions
| Type |
Meaning |
Duration |
| Permanent Exclusions |
Never covered under any circumstance |
Lifetime |
| Temporary Exclusions (Waiting Period)
| Covered after 1-4 years |
Limited Time |
| Condition-Based Exclusions |
Specific illnesses excluded by policy terms |
Varies |
| Treatment-Based Exclusions |
Certain procedures not covered |
Varies by plan |
| Geographical Exclusions |
Some plans exclude treatment abroad |
Policy dependent |
Common Permanent Exclusions
- Cosmetic or plastic surgery (unless due to accident).
- Dental & vision treatment (unless add-on).
- Infertility, IVF, or fertility treatments.
- Self-inflicted injuries or suicide attempts.
- Substance or alcohol-related conditions.
- Experimental or unproven treatments.
- HIV/AIDS and STDs (unless explicitly covered).
- War, nuclear, or terrorism-related injuries.
Common Temporary Exclusions (Waiting Period Based)
- Pre-existing diseases (2-4 years).
- Maternity & childbirth (2-3 years).
- Hernia, cataract, piles, or tonsillectomy (1-2 years).
- Joint replacement (2-3 years).
(Covered automatically once waiting period ends.)
Condition-Based Exclusions
- Illnesses resulting from non-disclosure of health history.
- Treatments outside policy validity period.
- Non-accidental injuries during adventure sports (unless covered by add-on).
Treatment-Based Exclusions
| Procedure |
Covered? |
Notes |
| Cosmetic / Aesthetic Surgery |
No |
Only if accident-related |
| Weight Loss Surgery |
No |
Unless medically necessary |
| Robotic Surgery |
Yes / No |
Depends on insurer & hospital |
| Organ Donor Expenses |
Yes / Partial |
Only donor’s surgery cost covered |
| Stem Cell / Gene Therapy |
No |
Experimental, not standard |
Local Insights For Hyderabad
- Most frequent exclusion causing rejection: Cosmetic surgery
- % of rejected claims due to exclusions: 22%
- Top insurers offering lowest exclusions: Care Health, HDFC ERGO, Star Health
- Most common excluded treatment: Dental procedures
How To Avoid Claim Rejection Due To Exclusions
- Read “Exclusions” and “Waiting Periods” in policy brochure before buying.
- Disclose complete medical history honestly.
- Choose plans with broader coverage or PED reduction riders.
- Use add-ons for maternity, OPD, and dental gaps.
- Renew policy on time to preserve continuity.
Smart Ways To Cover Exclusions
- Add Riders: Maternity, OPD, Dental, Critical Illness.
- Upgrade Plan: Higher-tier plans cover previously excluded procedures.
- Top-Up Policy: Extend coverage beyond sum insured limits.
- Buy Early: Waiting periods start counting sooner.
Policybachat Tip
“Always review Section 4 or 5 in your policy brochure - that’s where exclusions hide. Understanding them now avoids claim shocks later.”
Tax Note
Even for uncovered conditions, your premium payment still qualifies for Section 80D tax deductions.
FAQs
What are exclusions in health insurance?
Treatments or expenses not covered under your policy.
Are all exclusions permanent?
No - some (like maternity or PED) are temporary.
Is dental treatment covered?
Usually excluded unless added as rider.
Are pregnancy and childbirth covered?
Yes, only under maternity plans or after waiting period.
What if I hide a pre-existing disease?
Claim may be rejected for non-disclosure.
Are accidents covered immediately?
Yes, from day one - no waiting or exclusion.
Can exclusions change on renewal?
Not for existing policyholders, unless plan revised by IRDAI.
Is OPD covered under normal health plan?
No - only under specific OPD riders or top-tier plans.
Does NCB apply if I don’t claim due to exclusions?
Yes, NCB still applies for no claims.
Can PolicyBachat help me find fewer-exclusion plans?
Yes - we highlight all exclusions upfront before you buy.
Customer Reviews
- “Didn’t realize cosmetic surgery isn’t covered - now I know.” - Ravi Menon, Kochi
- “PolicyBachat explained exclusions clearly before purchase.” - Sneha Kapoor, Delhi
- “Good to know what’s not included before renewal.” - Kavya Nair, Bengaluru
- “Love how transparent this guide is.” - Ananya Deshmukh, Mumbai
- “Saved me from a claim rejection.” - Rajesh Rao, Hyderabad
- “PolicyBachat always shows exclusion lists upfront.” - Meera Iyer, Chennai
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