With our changing lifestyle choices, unhealthy eating habits and lack of physical movement or exercise it is becoming increasingly essential to focus on healthy habits. Medical insurance policies generally do not cover preexisting conditions, or conditions that could be a result of your genes.
When buying a Medical Insurance policy, its advisable that you evaluate the terms and conditions of the policy in terms of covering pre-existing conditions. Any insurance policy that refuses to cover your pre-existing conditions especially if you are over the age of 30 should be re-evaluated.
Even as an employer it is important that you read the fine print in the insurance policy coverage to ensure that your employees are receiving medical care that does not leave them in a situation. For instance, if person suffers from hypertension and the insurer leaves it out as a preexisting condition, then a stroke or a heart attack may not be covered in the policy. This can be problematic when medical treatment and tests are required.
What are Preexisting Conditions?
A preexisting condition is any medical condition that you have or can possibly have due to genetics or your health conditions. Insurance companies are quite particular about medical conditions that a person can have. This is because they may have to pay the insured if a medical condition arises from a pre-existing condition. Therefore, companies try to ensure that the person seeking insurance is healthy, and not making a choice to purchase insurance only to cover their existing medical condition.
With fast changing life styles and the demand from clients for extended coverage a lot of the pre-existing conditions such as Hypertension, Asthma, Cholesterol are now covered by Insurance Companies. However, Insurance companies may charge extra premium on coverage of a person with some diagnosed preexisting conditions.
When a Medical Insurance buyer continues his/her policy for a certain amount of years with the same Insurance Provider then the buyer’s Medical preexisting conditions are also included in the policy coverage. This can range anywhere from 2-5 years. It also depends on the type of illness. For example, Alliance EFU covers all Preexisting Medical conditions of the insurance buyer after he/she has been continuously covered under their policy for at least four years.
Until recently most health insurance companies would not cover medically diagnosed conditions that were under control with medication. However, Insurance trends are changing drastically with some insurance policies going a step further and covering Terminal illnesses as well such as cancer.
What other items may not be covered under insurance?
There are various procedures and therapies that may not be covered under a medical insurance policy, which you would have to discuss with your insurer. These may include outpatient and in-patient therapies. Dental Surgeries, Psychiatric treatment, Relationship therapy and Homeopathic treatments are examples of procedures that may not be included in a Medical Insurance policy.
What are Conditions and treatments that a Medical Insurance Company may not cover?
The following is a compiled list of conditions that may not be covered under a Medical Insurance Policy. You must evaluate your policy against this checklist to understand the full scope of policy coverage that you’re buying.
- Prolonged, hereditary and psychiatric health conditions
- Homeopathic, Herbal Treatments
- Acupuncture treatments
- Sexually Transmitted Diseases other than HIV/AIDS
- Body Massages and Spa treatments
- Dermatologists for Cosmetic Treatment
- Dental treatments including extractions, scaling or implants unless as a result of an injury/accident or otherwise covered under the policy
- Hearing Aids, Hearing tests if not as a result of a injury will not be covered
- Eye tests, Eyesight Correction Treatments, Laser Eye treatments, Eye Transplants and other Optical treatments unless caused by an injury or if stated by the insurer
- Puberty, Hormonal Replacement therapy, Menopause, Andro-menopause are not covered.
- Treatments related to fertility, sterilization and contraception
- Weight reduction procedures such as gastric sleeve, Gastric bypass
- Food Supplements, Vitamins, Protein Drinks and other nutritional supplements
- Organ transplants
- Pain Management
- Psychiatric or mental health treatments, including Relationship therapy, mental disorders
- Self-Abuse related to alcohol, drugs addiction, attempted Suicide and self-harm
- Expenses of staying at Old Age Homes
- Injuries caused by participating or indulging in adventure sports such as racing, hiking, go-karting, sky-diving, Scuba-diving, bungee jumping, and the likes of parasailing
- Plastic or Cosmetic Surgeries unless they are needed as a result of an accidental injury during the course of the insurance policy
- Injury caused as a result of taking part in demonstrations, strikes, riots
- Hemorrhoids, Fibroids, Hernia, Adenoidectomy
- Genetically passed Disorders and related conditions
- Injuries caused as a result of Car Racing, Speed driving or any other dangerous sports
- Injuries caused when serving the country’s armed forces, naval or air force.
- Vaccinations, Medical Check-ups or General Health Examinations
- Re-imbursement of transportation other than an ambulance provided for in-patient treatments
- Injuries caused as a result of war or terrorism
- Childbirth and pregnancy related issues if not completed 9 month of pregnancy period such as miscarriages, abortions
- Epidemics, diseases or injuries caused by natural disasters
Depending on your age, family size and lifestyle requirements, you should speak to your medical coverage provider to find out what may or may not be covered in your policy.