We would all like to be covered for critical illness. One of the major inspirations behind why people are interested in health insurance is that it would come in handy just when some of the major illnesses would have to be dealt with. However, mediclaim sometimes does not turn out to be as straight forward as it may seem.

1. Enlist some major exclusions under mediclaim policy
We would all like to be covered for critical illness. One of the major inspirations behind why
people are interested in health insurance is that it would come in handy just when some of the
major illnesses would have to be dealt with. However, mediclaim sometimes does not turn
out to be as straight forward as it may seem.
Just like it is vital that you are familiar with some of the key aspects associated with health
insurance policy, as in the case of riders, sum assured, and ways of going about health claims,
it is important for you to be aware of exclusions when it comes to your insurance policy. This
would help set realistic claims about health claims in medical insurance policy.
• Incongruence in hospitalisation: One of the major exclusions in terms of critical
illness occurs when the hospitalisation is not in line with the diagnosis and treatment
involved. You need to understand that mediclaim is meant for specific conditions, as
may be listed down as critical illness; hospitalisation that is not directly associated
with the illness would be excluded from health claims.
• Is the treatment medically necessary? This is a question that your mediclaim
insurance policy would be seriously concerned about. For critical illness or other
conditions not to be labelled under exclusions, it is important for the surgery or
treatment to be medically necessary. If treatment is an option, you could well expect
health claims to be excluded.
• Most dental treatments are exclusions. While you may have this as a thumb rule,
there are always exceptions. However, if the dental care is more of cosmetic in its
nature, or if the procedure is associated with orthodontics, your insurance policy may
treat it under exclusions.
• Pregnancy and associated complications are exclusions. Treatments in pregnancy
as well as treatments of complications including childbirth as well as abortions are
considered exclusions in health insurance. The exception to this rule is ectopic
pregnancy. However, in all other cases, you may not hope for health claims.
• Congenital disorders are generally excluded. If you have had a condition that has
been there right from birth, your health insurance policy may not be able to do much
about it.
• Is your hospitalisation purely diagnostic? If so, you may have problems in affecting
health claims. Diagnostic procedures need to be followed by active treatments for the
diagnosed conditions for the mediclaim policy to be of any use. If your hospitalisation
is purely diagnostic with no active treatment or follow-up, your health insurance
policy would not honour your claim.
• Alternative forms of treatments are exclusions. Health claims are normally
restricted to such forms of treatment as may be classified under the allopathic form of

2. medicine. If you were to opt for treatments in other forms of medicine, critical illness
or any other condition would not be able to secure the protection offered by
mediclaim or health insurance