Health insurance is a necessity to protect ourselves and our loved ones from unexpected health issues or emergencies.

Having health insurance provides us with a sense of security knowing that we can avail necessary treatment without worrying about the financial burden. However, it is important to understand that not all diseases or conditions are covered by health insurance policies, particularly after a certain duration.

Hence, it is crucial to understand what all diseases and conditions are not covered under health insurance policies after two years.

What is Pre-Existing Disease?

Pre-existing diseases or ailments refer to any health conditions that an individual may have had at the time of purchasing health insurance. Most health insurance policies have a waiting period of two to four years for pre-existing diseases.

During this waiting period, no claims can be made for the treatment of pre-existing diseases. After the waiting period, the treatment of pre-existing diseases is covered as per the terms and conditions of the policy. However, it is important to note that not all pre-existing diseases are covered under health insurance policies.

Diseases and Conditions Not Covered After Two Years

1. STDs

Sexually transmitted diseases (STDs) such as HIV or AIDS, Syphilis, Gonorrhoea, etc. are not covered after two years in most health insurance policies.

Since these diseases are usually contracted due to high-risk sexual behaviour, they are considered as a lifestyle-related disease that can be prevented with precautions. Hence, it is not considered as a necessary coverage in health insurance policies.

2. Cosmetic Surgeries

Most health insurance policies do not cover cosmetic or plastic surgeries, such as breast enhancement, rhinoplasty, facelift, etc. As these surgeries are considered to be elective or optional, the insurance companies do not cover them.

However, there are a few health insurance policies that cover certain cosmetic surgeries that are medically necessary, such as reconstructive surgeries after an accident or mastectomy.

3. Infertility Treatment

Infertility treatment, such as in vitro fertilization (IVF), is not covered by most health insurance policies after two years.

In some cases, the policies might cover infertility treatment but impose strict conditions, such as the age of the person, duration of infertility, or the number of attempts allowed. In general, the cost of infertility treatment is high, and it is advisable to purchase a separate health insurance policy for infertility treatment.

4. Cosmetic Dental Treatments

Cosmetic dental treatments, such as teeth whitening, implants, veneers, are not covered by most health insurance policies after two years.

However, dental insurance policies might cover some of these treatments, but they have a separate waiting period and premium. In general, basic dental treatments, such as routine check-ups, scaling, and fillings, are covered under most health insurance policies.

5. Sleep Apnea and Insomnia

Most health insurance policies do not cover sleep apnea and insomnia after two years as these conditions are considered as lifestyle-related disorders.

However, some policies might cover the treatment of sleep apnea if it is diagnosed as a result of a medical condition, such as obesity or hypertension.

6. Weight Loss Surgery

Weight loss surgery, such as gastric bypass or laparoscopic sleeve gastrectomy, is not covered by most health insurance policies after two years.

This is because weight loss surgery is considered to be an elective or optional procedure, and insurance companies do not cover it. However, some policies might cover weight loss surgery in certain cases, such as if the person has a BMI over 40 or if there are other medical complications related to obesity.

7. Drug Abuse and Alcoholism

Most health insurance policies do not cover drug abuse or alcoholism after two years. This is because these conditions are considered to be lifestyle-related diseases and can be prevented with precautions.

However, some policies might cover the treatment of drug abuse or alcoholism if it is diagnosed as a result of an underlying medical condition or if it is covered under mental health coverage.

8. Alternative Therapies

Most health insurance policies do not cover alternative therapies, such as ayurveda, homeopathy, acupuncture, or naturopathy, after two years.

This is because these therapies are not considered to be medically necessary and are not proven to be effective in treating diseases or ailments. However, some policies might cover alternative therapies in certain cases, such as if they are recommended by a medical practitioner or if they are part of a wellness program.

9. Non-Prescription Medications

Most health insurance policies do not cover non-prescription medications, such as vitamins, health supplements, or over-the-counter drugs, after two years.

This is because these medications are not considered to be medically necessary and do not require a prescription from a doctor. However, some policies might cover certain non-prescription medications, such as insulin or blood glucose monitors, if they are essential for managing a medical condition.

10. Maternity Expenses

Most health insurance policies have a waiting period of two to four years for covering maternity expenses. During this waiting period, no claims can be made for maternity expenses, such as delivery, hospitalization, or postnatal care.

After the waiting period, maternity expenses are covered as per the terms and conditions of the policy. However, not all health insurance policies cover maternity expenses in full. Some policies might impose a limit on the amount of coverage or the number of deliveries allowed.

Conclusion

It is crucial to understand the diseases and conditions that are not covered after two years in health insurance policies. This knowledge will help you make an informed decision while selecting a health insurance policy that best suits your needs.

It is also advisable to read the policy documents thoroughly and consult with the insurance provider or agent if you have any doubts or queries.