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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