Health Insurance Coverage Inclusions & Exclusions
Understanding the Inclusions & Exclusions in Health Insurance coverage
Health concerns can arise anytime, regardless of how old or young, healthy or unhealthy you are. We might suddenly need to be hospitalised, which would be very stressful for us emotionally and financially.
It is preferable to plan ahead and invest in a decent, all-inclusive health insurance policy that offers coverage for various ailments and diseases rather than stressing on how finances may be managed in such difficult times.
Additionally, it’s vital to read the terms and conditions to fully understand the details of your insurance policy, including the list of illnesses that are not covered by health insurance.
What is covered in health insurance?
Some of the common medical expenses covered by health insurance include:
In-Patient Hospitalisation / Daycare Expenses – As long as the Hospitalisation lasts longer than 24 hours, the hospitalisation costs incurred during the treatment of a sickness or injury are covered. In addition, daycare procedures are covered.
Pre-Existing Illnesses or Diseases – You can get covered for treating any pre-existing illness or condition after the waiting time has expired.
Pre and Post-Hospitalisation Expenses – The insurance provider will pay pre and post hospitalisation expenses like Investigations, consultation and medicine charges when the Hospitalisation is admissible as per the policy terms and conditions.
Ambulance Charges – The expenses incurred for transportation of the insured person by ambulance service from one hospital to another is covered and the amount of coverage is as per the Policy terms and conditions.
Delivery and Newborn Cover – The cost of delivery and the newborn baby coverage is provided only in certain policies and coverage period differs from policy to policy.
Preventive Health Checkups – The insurer provides health Checkups in certain policies every claim-free year. In some of the other policies, preventive Health checkups are provided when the policy is in force.
Daycare Treatment – Daycare treatment means medical treatment and/or surgical procedure which is undertaken under General or Local Anesthesia in a hospital/daycare centre in less than 24 hrs because of technological advancement and which would have otherwise required Hospitalisation of more than 24 hours
AYUSH Benefit – A health insurance policy may also cover the expenses of Ayurveda, Unani, Siddha, and homoeopathy treatments based on the policy terms and conditions
What isn’t covered in health insurance?
The following medical expenses are not covered by a health insurance plan:
- Expenses related to the treatment of any illness within 30 days from the first policy commencement date shall be excluded except claims arising due to an accident, provided the same are covered.
- Claims arising out of adventure sports injuries.
- Injuries caused by war, terrorism, or nuclear activity are not covered under health plans.
- Hospitalisation due to self-inflicted injuries is not payable.
Cosmetic surgeries like Liposuction, Botox, implants and similar surgeries are excluded from a health insurance policy.
Understanding your policy
It’s important to buy health insurance that covers your requirements and needs. Consider your family’s and your medical requirements, and choose a plan that provides the appropriate benefits.
Comparison of various plans based on their coverage, benefits, and costs is one of the best ways to choose a health insurance. Comparison enables you to identify the plan that provides the greatest coverage within the budget. Read and understand the wording of the insurance policy carefully to choose the right health insurance policy.
It’s important to understand your health insurance policy, benefits, coverage and requirements to ensure you receive the care you need and avoid unexpected costs. Hence, get yourself secured with good health insurance plans to safeguard you and your family from unexpected financial hassles
HELP CENTRE
Confused? We’ve got the answers
We're Star Health. We offer the coverage that's designed to help keep you healthy. It's the care that comes to you and stays with you.
The exclusions in health insurance give you knowledge that helps you make informed decisions, select the correct policy for your requirements, and set realistic expectations for your health insurance coverage. You check the health insurance exclusions to understand what the health insurance policy does not cover, preventing unexpected out-of-pocket costs for some diseases, treatments, or situations, in order to avoid claim rejections and financial strain. The health insurance exclusions give you clarity about the health insurance.
A 2 year exclusion for health insurance, where a few conditions, such as pre-existing diseases (e.g., hernia, cataracts, joint replacements) are not covered for the first two years, is general and can be a valuable portion of a health policy if you are healthy at the time of buying. An exclusion in health insurance ensures that you don't have to pay for conditions you didn't have before purchasing the plan and that are covered following the waiting period, preventing a claim rejection. The specific medical conditions covered after an exclusion in health insurance differ by policy, but generally include pre-existing conditions.
There is a list of diseases not covered under health insurance. In general, health insurance does not cover elective cosmetic surgeries, pre-existing diseases during the initial waiting period, infertility treatments (such as IVF), treatments for illnesses due to substance abuse or self-inflicted harm, and a few alternative or non-allopathic therapies. Knowing the list of diseases not covered under health insurance will ensure that you have clarity while buying health insurance.
Star Health Insurance plans have some exclusions and limitations that you should be aware of before buying or renewing your policy.
Health insurance policies have certain limitations in medical coverage. Common limits include waiting periods for specific conditions, caps on room rent, sub-limits on certain treatments, and exclusions for some illnesses or procedures. Some plans may also not cover OPD care, maternity benefits, or pre-existing conditions immediately. Always review your policy document to understand these limits before using your benefits.
Exclusions list what the policy does not cover. Knowing them early helps avoid surprises during claims. For e.g. Cosmetic surgery done only for appearance (not due to an accident) is usually excluded.
Not necessarily. Exclusions simply list what isn’t covered to avoid confusion. Knowing them early helps you plan better and avoid unexpected claim rejections.
You can review your policy details in the STAR Health App or raise a query there to get clear, personalised guidance from our support team.
Certain treatments, conditions, or expenses are excluded to keep the policy affordable. These exclusions are clearly listed in your policy document.
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Health Insurance Coverage for pre-existing medical conditions is subject to underwriting review and may involve additional requirements, loadings, or exclusions. Please disclose your medical history in the proposal form for a personalised assessment.
The information provided on this page is for general informational purposes only. Availability and terms of health insurance plans may vary based on geographic location and other factors. Consult a licensed insurance agent or professional for specific advice. T&C Apply. For further detailed information or inquiries, feel free to reach out via email at marketing.d2c@starhealth.in
