List of Common Exclusions Under Health Insurance Policy

Exclusions in health insurance are conditions or treatments not covered, such as pre-existing diseases, pregnancy, self-inflicted injuries, cosmetic procedures, and adventure sports. Insurers set exclusions to manage risk and keep policies affordable.
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3 min
21-April-2025

Health insurance is your safety net—but only if you know what it doesn’t catch. 
While a good policy protects you from soaring medical bills, it’s equally important to understand what it won’t cover. These uncovered conditions—called exclusions—can leave you footing the bill if you’re caught unaware.

Before you rely on your policy during a health emergency, take a moment to review the fine print. In this article, we’ll break down the top 10 common health insurance exclusions and explain why understanding them is just as crucial as knowing your benefits.

The best time to learn about exclusions is before you buy. Compare plans side by side to avoid gaps and get the cover that truly fits your health goals.

Why should you check exclusions before buying health insurance?

Before purchasing health insurance, it is imperative to carefully review the policy document and understand the exclusions. Failing to do so may lead to misunderstandings and financial setbacks when making a claim. Here are some key reasons why checking exclusions is crucial:

  • Clarity on coverage:
    Reviewing exclusions helps you gain clarity on what is covered and what is not under your health insurance policy. This knowledge allows you to make informed decisions about your healthcare and financial planning.
  • Financial preparedness:
    Knowing the exclusions helps you financially prepare for potential expenses that may not be covered by your health insurance. This ensures that you are not caught off guard during a medical emergency or planned medical procedures.
  • Avoiding disputes:
    Understanding exclusions prevents disputes with the insurance company during the claims process. Being aware of the limitations of your policy can help you navigate the claims process smoothly and reduce the chances of claim rejection.
  • Choosing the right policy:
    Different health insurance policies have varying exclusions. By carefully examining the exclusions, you can choose a policy that aligns with your health needs and preferences.
  • Managing expectations:
    Knowing the exclusions sets realistic expectations regarding your health insurance coverage. It prevents assumptions that may lead to disappointment when specific healthcare expenses are not covered.

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What are the common exclusions of health insurance

  • Pre-existing conditions:
    Most health insurance policies have exclusions for pre-existing conditions. A pre-existing condition refers to any medical condition that you had before purchasing the policy. You can get an add-on for pre-existing disease cover.
  • Waiting Period Clause
    Every policy includes a waiting period for specific treatments or diseases—usually 30 days for general illness and up to 2–4 years for major surgeries or pre-existing conditions.
  • Non-Medical Expenses
    Items like gloves, masks, oxygen masks, registration charges, and administrative costs are usually not covered under standard policies. Always check the list of non-payables in your policy.
  • OPD Treatments
    Outpatient treatments, including routine doctor visits, dental care, and minor procedures not requiring hospitalization, are generally excluded unless specifically covered in your plan.
  • Obesity Treatments
    Weight loss surgeries or treatments related to obesity, unless prescribed due to life-threatening complications, are often excluded as they’re considered lifestyle-related.
  • Sexually Transmitted Diseases (STDs)
    Conditions like HIV/AIDS or other STDs are typically excluded due to their long-term treatment needs and non-curative nature, unless mentioned in a critical illness policy.
  • Dietary Supplements
    Health tonics, protein powders, or vitamins not prescribed by a doctor as part of a treatment plan are usually excluded as they are considered general wellness items.
  • War & Related Perils
    Medical issues arising from war, terrorism, civil unrest, or nuclear activity are not covered as they fall under high-risk exclusions outside the insurer’s control.
  • Assisted Reproductive Technology (ART)
    Treatments like IVF, IUI, and other infertility-related procedures are excluded unless the policy explicitly covers them as part of maternity or fertility benefits.
  • Hazardous or Adventure Sports
    Injuries from activities like skydiving, rock climbing, or bungee jumping are excluded since they involve intentional risk and are not medically necessary.
  • Congenital Disorders
    Birth defects or congenital anomalies present since birth are not covered unless the insurer offers a specific rider or plan extension for such conditions.
  • Cosmetic surgery:
    A health insurance policy may not cover cosmetic procedures such as facelifts, rhinoplasties, or liposuction, as they are typically voluntary and not necessary for medical reasons.
  • Dental care:
    Standard health insurance policies often do not cover dental care, such as fillings, crowns, root canals, and dentures. However, most insurers provide separate dental insurance policies that focus on dental care.
  • Experimental procedures:
    Health insurance policies usually do not cover experimental procedures such as stem cell therapy, which is still in the trial phase.
  • Alternative medicine:
    Alternative therapies like acupuncture, homoeopathy, and naturopathy are typically not covered by health insurance policies.
  • Maternity care:
    Some health insurance policies may not cover maternity care, including prenatal, delivery, and postnatal care.
  • Weight-loss surgery:
    Most health insurance policies have exclusions for weight loss procedures, such as gastric bypass surgery, which are primarily performed for cosmetic purposes.
  • Self-inflicted injuries:
    Suicide attempts, self-harm, or intentionally putting oneself in harm's way, such as consuming toxic substances or drugs usually are not covered in a health insurance policy.
  • Pregnancy and fertility:
    Many health insurance policies exclude infertility treatments, including in-vitro fertilisation, as well as procedures related to pregnancy such as childbirth and abortion.
  • Medical treatment overseas:
    Health insurance policies may have exclusions for medical care outside the country, even in case of an emergency medical evacuation.

How to check the exclusions in your health insurance policy?

Exclusions can turn your health cover into a surprise expense. Here’s how you can make sure you know exactly what your plan won’t pay for—before you need it:

  • Read the fine print: Go through your policy document and look for the 'Exclusions' or 'What’s Not Covered' section.

  • Ask directly: Don’t hesitate to get a written list of exclusions from your insurer or agent.

  • Watch for waiting periods: Some illnesses (like hernia or cataracts) are covered only after a certain time.

  • Check IRDAI-standard exclusions: These include things like cosmetic surgeries, self-inflicted injuries, or alternative therapies unless specifically included.

  • Compare before you commit: Every policy has different exclusions—comparing plans helps you choose smarter.

Look for health insurance plans with fewer exclusions and shorter waiting periods. Start with a side-by-side quote comparison—it takes just 2 minutes. Get instant quotes

Ways to minimize the impact of health insurance exclusions

While exclusion in health insurance can’t be completely avoided, you can reduce its impact by:

  • Choosing add-on covers for pre-existing diseases or maternity.
  • Opting for comprehensive plans with minimal exclusions.
  • Starting early to reduce waiting periods.
  • Keeping detailed medical records to avoid claim disputes.

Conclusion

When buying a health insurance policy, don’t just focus on what’s covered—pay close attention to what’s not. Understanding the exclusions can help you avoid denied claims and unexpected expenses during critical times. By knowing the common exclusions upfront, you can choose a plan that actually fits your healthcare needs—without gaps.

Before you commit, compare different health insurance plans side-by-side to see which one offers the best balance of benefits, exclusions, and value. And most importantly, always read the policy document carefully, review the fine print, and ask questions until you’re confident.

Want to skip the jargon? Use Bajaj Finance Insurance Mall to compare health plans quickly—check exclusions, get quotes, and buy online in just a few clicks. Compare plans from leading insurers 

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Frequently asked questions

What are the exclusions of health insurance policy?

Exclusions in a health insurance policy refer to specific medical conditions, treatments, or scenarios that the insurer will not cover. These typically include pre-existing diseases (within a waiting period), cosmetic surgeries, injuries due to hazardous sports, self-inflicted harm, and illnesses caused by substance abuse. Understanding exclusions helps prevent claim rejections later.

What is not covered in a health insurance policy?

Health insurance policies do not cover non-medical expenses like hospital registration fees, dietary supplements, or over-the-counter vitamins. Treatments for HIV/AIDS, infertility, congenital anomalies, and OPD consultations are also commonly excluded unless your plan specifically includes them. Always check the policy brochure to know what's not covered.

What are typical exclusions in an insurance policy?

Typical exclusions in an insurance policy include pre-existing conditions (for a certain period), STDs, cosmetic or weight-loss surgeries, and any health issues arising from war, riots, or participation in dangerous activities. These exclusions help insurers manage high-risk scenarios and are usually detailed in the policy’s terms and conditions.

What are the 2 year exclusions?

Two-year exclusions refer to specific diseases or treatments that are not covered for the first 24 months of the policy. These commonly include hernia, cataracts, joint replacements, and certain surgeries. After completing the waiting period without any claim, coverage for these treatments is typically activated.

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*T&C Apply - Bajaj Finance Limited (‘BFL’) is a registered corporate agent of third party insurance products of Bajaj Allianz Life Insurance Company Limited, HDFC Life Insurance Company Limited, Life Insurance Corporation of India (LIC), Bajaj Allianz General Insurance Company Limited, SBI General Insurance Company Limited, ACKO General Insurance Company Limited, HDFC ERGO General Insurance Company, TATA AIG General Insurance Company Limited, ICICI Lombard General Insurance Company Limited, New India Assurance Limited, Chola MS General Insurance Company Limited, Zurich Kotak General Insurance Company Limited, Star Health & Allied Insurance Company Limited, Care Health Insurance Company Limited, Niva Bupa Health Insurance Company Limited, Aditya Birla Health Insurance Company Limited and Manipal Cigna Health Insurance Company Limited under the IRDAI composite registration number CA0101. Please note that, BFL does not underwrite the risk or act as an insurer. Your purchase of an insurance product is purely on a voluntary basis after your exercise of an independent due diligence on the suitability, viability of any insurance product. Any decision to purchase insurance product is solely at your own risk and responsibility and BFL shall not be liable for any loss or damage that any person may suffer, whether directly or indirectly. For more details on risk factors, terms and conditions and exclusions please read the product sales brochure & policy wordings carefully before concluding a sale. Tax benefits applicable if any, will be as per the prevailing tax laws. Tax laws are subject to change. BFL does NOT provide Tax/Investment advisory services. Please consult your advisors before proceeding to purchase an insurance product. Visitors are hereby informed that their information submitted on the website may also be shared with insurers. BFL is also distributor of other third-party products from Assistance service providers such as CPP Assistance Services Private Limited, Bajaj Finserv Health Limited. etc. All product information such as premium, benefits, exclusions, value added services etc. are authentic and solely based on the information received from the respective Insurance company or the respective Assistance provider company.

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