Looking At Some Common Exclusions In Group Health Insurance

Group health insurance is normally offered by companies to their employees as one of the perks of the job. Being covered under this policy is really beneficial as it is often the first type of health insurance held by most. Though the coverage is basic, it is still better than having no form of health insurance at all. Added to that, a lot of companies offering group health insurance also allow the insured members to buy coverage for their families too under the same policy, albeit at an additional cost.

Now, even if you are covered under a group health insurance policy, it is important to understand that the coverage is not all-inclusive. Just like with an individual health insurance policy, group Mediclaim also has certain limitations. In this article, we take you through some of the main exclusions of group health insurance.

  • Obesity treatment

Group health insurance will generally not cover you for obesity-related illnesses and weight management treatments.

  • Dangerous activities/sports

The insured individual will not be covered if they require treatment due to their participation in certain hazardous activities as mentioned in the policy. These activities can include dangerous sports such as motor racing, paragliding, and rock climbing, among others.

  • Non-medical expenses

The insured individual cannot make claims on non-medical expenses. For instance, if the person makes use of chargeable telephone services at the medical facility, they cannot include this expense in their claim. If they decide to stay in hospital even though there is no active treatment going on, they may not make a claim.

  • Certain alternate treatments

Insured policyholders will not be able to make claims for massages, steam bath, naturopathy, and ayurvedic treatment. Group health insurance also does not cover any kind of supplements, like vitamins and tonics, unless these are directly required for an illness that is covered in the policy and being treated.

  • Convalescent care

Group health insurance also generally will not cover you for expenses incurred in a convalescent home. Charges for doctor’s home visit fees (during the pre- and post-hospitalisation phases) and private nurse charges may also be excluded.

  • Cosmetic dental treatment

Cosmetic dental procedures – such as cavity filling – will not be included. Certain dental procedures may be covered, if they are directly linked with the disease for which the patient is being treated.

  • Other exclusions

Group health insurance will also generally not cover you for complications arising out of HIV/AIDS, self-harm, war, and intoxication or substance abuse. Hearing aid devices, spectacles, and contact lenses too will not be covered. Furthermore, treatments such as inoculations, vaccinations and circumcision may also not be covered.

  • Service charges

Most group health insurance policies do not cover service charges either. These might include surcharges, admission fees, registration fees, and any other similar charges levied by the medical centre.

There may be further exclusions to coverage that can vary between insurers. Do be sure to read the fine print of your group health insurance policy.

To enjoy proper coverage, it is recommended that you also have an individual health insurance policy too. Remember that your coverage under the group health insurance plan is only active as long as you are an employee of the company. The moment you leave, you are left at risk without coverage until you join your next job (provided that they offer you group Mediclaim).

We hope that this article will help you understand a bit more about what you can expect from group health insurance. Take care.

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