While health insurance covers a broad range of medical expenses, certain treatments and situations are excluded from coverage. Exclusions ensure that policies remain financially viable while discouraging unnecessary or high-risk claims.

Standard Exclusions:These are exclusions that apply to all policyholders, regardless of age or health condition.

• Diagnostic & Evaluation Procedures – Hospital admissions for diagnostic tests alone are not covered unless followed by active treatment.
• Rest Cure & Rehabilitation (Excl05) – Admissions solely for bed rest, rehabilitation, or respite care (including custodial care or terminal illness care) are not covered.
• Obesity & Weight Control – Bariatric surgery is only covered if medically necessary, based on BMI and severe co-morbidities.
• Gender Transition Treatments – – Expenses related to gender reassignment surgery or hormone therapy are excluded.
• Cosmetic or Plastic Surgery – – Aesthetic procedures are excluded unless required due to an accident, burns, or cancer.
• Hazardous Activities – – Treatment for injuries sustained during adventure or professional sports (e.g., skydiving, racing, mountaineering) is excluded.
• Breach of Law– – Claims arising from unlawful activities or criminal intent are not covered.
• Excluded Providers – – Treatment from blacklisted hospitals or doctors is excluded unless it’s an emergency or life-threatening situation.
• Alcoholism & Drug Abuse – – No coverage for conditions arising due to alcohol, drugs, or substance abuse.

• Alternative & Non-Medical Treatments such as:
  • Treatments in health resorts, spas, or nature cure clinics.
  • Over-the-counter dietary supplements, vitamins, and minerals unless prescribed.
  • Eye treatments for refractive errors below 7.5 diopters.
  • Experimental treatments lacking strong medical evidence.
• Sterility & Infertility – No coverage for contraception, IVF, surrogacy, or sterilization reversal.
• Maternity – Normal childbirth, C-sections, and miscarriages (unless accident-related) are excluded unless specified otherwise.

Specific Exclusions:

• War & Nuclear Exposure – No coverage for war, biological/nuclear attacks, or military service-related injuries.
• Self-Inflicted Injuries & Suicide Attempts – Any injury due to self-harm or attempted suicide is excluded.
• Military & Defense Operations – No coverage for injuries sustained during military or air force operations.
• Sleep Disorders & General Debility – Investigative treatments for conditions like sleep apnea, chronic fatigue, or exhaustion are excluded.
• Congenital External Diseases – Birth defects that require medical treatment may not be covered unless specified in the policy.
• Stem Cell Harvesting – Procedures related to stem cell storage and transplantation are typically not covered unless explicitly included.
• Non-Medical Expenses – Charges for food, toiletries, laundry, and personal items in hospitals are not covered.
• Outpatient & Lifestyle-Related Expenses such as:
  • Routine dental, vision, and hearing aids.
  • Hair loss treatments, wigs, and baldness-related procedures.
  • Prosthetics and medical devices unless used during surgery.

Note: The information provided herein is for general informational purposes only and is intended to serve as an illustrative guide. Specific document requirements, notification time frames, and procedural details may vary significantly between different insurers and policies. This summary is not intended to be comprehensive or a substitute for the actual policy wording. For precise and up-to-date information, please refer to your insurer’s official policy documents or contact them directly.