What is not covered in health insurance?
Every health policy has exclusions — things it will never pay for — plus items that are only partly paid. Knowing them upfront is how you avoid a nasty surprise at claim time. Broadly, exclusions fall into permanent exclusions, waiting-period exclusions, and non-payable items.
Permanent exclusions
These are never covered, such as cosmetic or aesthetic procedures (unless reconstructive after an accident), routine dental and vision (unless due to injury), self-inflicted harm, and treatment outside what the policy defines as medically necessary. The exact list is in your policy wording.
Waiting-period exclusions
Some things are covered later, not now: pre-existing diseases, specific named ailments, and an initial waiting period for most illnesses at the start of the policy. See PED waiting period and initial waiting period.
Non-payable items and partial deductions
- Consumables: gloves, syringes, PPE and similar are often non-payable without an add-on.
- Room-rent overage: exceeding your room limit can trigger a proportionate deduction across the bill.
- Co-pay and sub-limits: your share and per-item caps reduce the payout within the sum insured.