Despite promising financial security during medical emergencies, Indian health insurance policies routinely exclude a wide range of critical illnesses and treatments. A verified list of exclusions paints a grim picture of how individuals with life-threatening, congenital, or chronic conditions often find themselves without coverage—regardless of policy tenure or premium value.
Permanently excluded conditions include:
- Congenital heart disease
- Epilepsy and Parkinson’s disease
- Stroke, paralysis, and Alzheimer’s
- Chronic liver and kidney diseases
- Multiple sclerosis, HIV/AIDS, and certain cancers
- Severe pancreatic disorders and hearing loss
These exclusions highlight a systemic issue: patients diagnosed with these illnesses are left to fend for themselves.
Pre-existing Conditions: The 48-Month Disqualification Trap
The fine print of most policies reveals a critical catch—any disease diagnosed within 48 months prior to purchasing a plan is marked as “pre-existing.” This label doesn’t just delay coverage; it often invalidates it entirely for years.
Prevalent lifestyle-related conditions affected by this clause include:
- Diabetes
- High blood pressure
- Asthma
- Thyroid disorders
- Arthritis
Given the widespread nature of these conditions in India, the implications are severe: millions of policyholders are unknowingly paying premiums for diseases they can’t claim for.
Two Years Too Late: Conditions With Delayed Access
Even for conditions considered treatable or routine, fixed waiting periods of up to 2 years are imposed. These include:
- Cataracts
- Kidney stones
- Joint replacement surgeries
- Hernia repairs
- Osteoarthritis and osteoporosis
- ENT conditions like tonsils, sinus issues, and nasal polyps
- Varicose veins
This approach prioritizes cost control over urgent care, delaying treatments at the expense of patient health.
Ongoing Treatments and Modern Needs Often Denied
Another troubling trend is the frequent rejection of ongoing or recurring treatments, especially those involving long-term cancer care, chronic diabetes management, or hypertension.
Additionally, modern medical needs are excluded under the label of “non-essential,” including:
- Cosmetic surgeries
- IVF and infertility treatments
- Dental, vision, and hearing aids
- Weight-loss procedures
These exclusions reflect a coverage model that’s not just outdated, but alarmingly disconnected from evolving medical realities and patient needs.
A Call for Reform and Transparency
This exclusion list serves as a sobering reminder: health insurance in India is far from universal health security. Without clear disclosures and regulatory oversight on exclusions and waiting periods, millions remain vulnerable—unaware that their most urgent health needs may never be covered.
