9 Health Conditions Generally Not Covered Under Health Insurance Policy

  • Author :
  • TATA AIG Team
  • Published on :
  • 26/10/2021

A health insurance policy is a must in today’s world, given the rising cases of lifestyle diseases, health issues, high medical inflation, etc. With a well-planned policy, you can enjoy several health insurance benefits that can save you and your family from dipping into your savings or wasting money.

But did you know that even the most comprehensive health insurance policies have a set of exclusions or do not cover specific health conditions? If not, find out what these exclusions are so that you can make an informed choice while selecting a medical insurance plan.

Health Conditions your Medical Insurance Plan Won’t Cover

When choosing from our Tata AIG MediCare line of health insurance plans, compare all the plans using our health insurance calculator to find the exact nature and extent of coverage you are looking for. Compare Health Insurance policies helps you understand what pre-existing health conditions are not covered under the policies.

It is true that having a health insurance policy does take a lot of stress away since medical emergencies can be taken care of easily. But before you buy a health insurance policy, know that there are situations, conditions and treatments that medical insurance plans do not cover.

List of diseases that are not covered under health insurance policy.

  • Cosmetic Surgery

Cosmetic surgeries are not covered under medical insurance plans because they are not considered to be crucial or life-saving and do not contribute to the quality of life in medical terms. Such treatments include lips or breast augmentation, botox injections, facelifts, etc. These procedures are only meant to help enhance your beauty or physical appearance and do not necessarily facilitate or improve any body function.

  • Health issues from excessive consumption of intoxicating substances

Everyone knows how fatal drugs, smoking and overdose of alcohol can be. People who consume these products habitually are quite likely to be affected by lifestyle diseases as compared to others who abstain from these substances. Regular consumption of these products can cause severe damage to your lungs, liver, mouth and also cause cancer and stroke. But since the consumption of these substances is voluntary, medical insurance plans might exclude such claims. However, insurance companies consider such claims on a case-by-case basis.

  • Congenital Diseases or Genetic Disorders

Congenital diseases or conditions are those with which a person is born. Such conditions can be internal such as an exceptionally weak internal organ, or external conditions, such as a recurring skin condition. Before you buy your health insurance plan, always inform your insurer about any congenital disease that you may have. Even though the health insurance policy may not cover these conditions, the information gives more clarity to the insurer.

  • Voluntary Abortion

Pregnancy may not always go as planned. With the introduction of the Medical Termination of Pregnancy (MTP) Act in 1971 and the amendment of this act in 2003, women can now access safe and legal abortion procedures. However, if the abortion is voluntarily undertaken without a doctor’s recommendation, your medical insurance plan will not be able to cover any complications arising out of the procedures.

  • Pregnancy-related complications

Having a baby is a delicate process and can be quite expensive too. If you are planning a child and need to be covered by a health insurance plan, go for a specific health insurance plan with an inbuilt maternity cover that can be better equipped to handle pregnancy and birth complications than the usual health insurance cover.

  • IVF and Infertility Treatments

In vitro fertilisation and fertility treatments are not covered under all health insurance policies because these are planned medical procedures and are extremely expensive. Since medical insurance policies are meant for sudden and unexpected accidents or injuries or emergency treatments, infertility procedures and treatments cannot be covered under health insurance.

  • Transmitted diseases

Not many health insurance policies in India cover transmitted diseases such as Sexually Transmitted Diseases (STD), gonorrhoea, HIV, etc. Even these health policies offer limited coverage. This is because the treatment of such diseases continues for the whole life and is very expensive. Hence, transmitted diseases are mostly an exclusion under a majority of health insurance plans.

  • Pre-existing Medical Condition

Health insurance policies have a waiting period for pre-existing diseases and conditions ranging from 2-4 years. Apart from that, there is also an initial waiting period of 30 days, common for all health insurance policies. Also, if you already are suffering from a disease or an illness before you buy the health insurance, make sure you inform the insurance company about the same. Either your health insurance policy will exclude pre-existing medical conditions, or you will have to abide by the waiting period.

  • Self-inflicted Injury

While your medical insurance plan may come to your aid in case of accidental injuries and wounds, the same does not count when it comes to self-harm or intentional injuries inflicted on oneself. It is advisable to get professional help for your mental well-being if you are likely to inflict any injuries on yourself.

Tata AIG Health Insurance Plans

A health insurance plan is meant to be quite comprehensive in nature so that you do not have to face inconveniences or a shortage of financial assistance in times of need.

Tata AIG health insurance offers the MediCare line of health insurance policies, with three different variants customised to suit your unique needs. Our health insurance plans vary and offer coverage for different diseases covered by health insurance.

You can avail of individual health insurance and family floater plans, along with a COVID-19 cover and a personal accident cover. You can also choose the Tata AIG MediCare Plus Super Top-up plan to get additional coverage, over and above your base health plan.


Many a time, you may be tempted to choose a medical insurance plan based only on what it offers and how much it costs. However, these exclusions are important facilitators when it comes to deciding the type of health policy you want.

Disclaimer / TnC

Your policy is subjected to terms and conditions & inclusions and exclusions mentioned in your policy wording. Please go through the documents carefully.

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