7 Situations That Are Excluded From Coverage Under Critical Health Insurance

 Critical Illness insurance is a policy that pays you a lump sum if you are diagnosed with certain pre-listed critical diseases. Illnesses such as cancer, heart attack, end stage renal disease, complete blindness, and multiple sclerosis generally fall under the purview of critical illness coverage.

The critical illness insurance payout can be used for any expenses as deemed fit by the policyholder. This means that they could use the funds to pay household bills, buy the groceries and even keep domestic help. Do bear in mind that patients with critical illnesses often cannot go to work due to their failing health and constant need for medical treatment. Thus, critical illness insurance is truly a lifesaver. 

While we can see how utterly essential critical illness coverage is, it is also important to note that the policy has certain limitations. To that effect, here are 7 situations that are generally excluded from critical illness insurance plans.  

1. Surgeries due to adventurous sports

Any injuries sustained due to participation in dangerous sports will not qualify for coverage under critical illness insurance. For instance, critical illness coverage normally includes a payout if the patient suffers permanent paralysis of the limbs; however, if the paralysis occurs as a result of a sporting activity, the claim will not hold. 

2. Injuries due to self-harm

If a patient suffers from a critical illness that is directly the result of self-harm, the critical illness policy will not honour the claim made.  

3. Claims for war-related injuries

This exclusion states that no claims may be made for injuries that may have arisen out of war, civil war, rebellion, or insurrection.

4. Illnesses arising from substance abuse

Any illnesses that occur due to the abuse of banned substances (narcotics) and alcohol are not covered under a critical illness insurance plan. For instance, critical situations such as a drug overdose will not see the policyholder get a payout. 

5. Situations of breach of law

Any claim that is directly related to a situation that involves a breach of legal regulations will not be honoured. This exclusion holds true whether or not the policyholder acted with criminal intent. 

6. Claims arising due to active duty

If the policyholder is taking part in any kind of national military, naval or airforce activity, they are not eligible for claims under a standard critical illness insurance policy. 

7. Incidents of nuclear damage

Any kind of injury or illness that is directly caused by ionizing radiation or hazardous emissions from a nuclear plant will not be covered under the provisions of a standard critical illness insurance plan. 

Do bear in mind that this is an overview of the major exclusions observed by insurance providers under critical illness plans. There may be more exclusions that can vary between companies. Do be sure to read the policy details before signing up and paying your premium. Knowing what you can and cannot make claims for will save you from the hassles of facing a rejection when you need a payout. 

We hope this article will prove helpful and informative for you. Take care. 

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