When applying for health insurance, it is always important to check the terms and conditions for any health exclusions. this refers to things that are not covered or are “excluded” from your policy.
While having private health insurance covers many things, such as physical therapy, diagnostic tests, and hospital treatment, there are exclusions that are unlikely to be covered, such as:
- pre-existing medical conditions
- chronic conditions
- dental work
- prescription drugs
- cosmetic surgeries
- other exclusions, eg, infertility, routine pregnancy, speech therapy
- alcohol, drug or substance abuse
- allergies or allergic disorders
- birth control, infertility, sexual problems and gender reassignment
- treatment to correct vision (for example, long or short)
- genetic tests, health screenings, or vaccinations
- intensive care (except in some specific circumstances)
- learning difficulties, behavioral and developmental problems
- treatment and repatriation abroad
- pregnancy and routine childbirth (although certain complications of pregnancy may be covered)
- professional sports injuries
- puberty, menopause and aging
- self-inflicted injury or suicide
- sleep problems and disorders
- treatments to lose weight
pre-existing medical conditions
A pre-existing medical condition is one for which you had symptoms, medications, or treatment prior to the start date of a new health insurance policy, and may still be receiving treatment.
This could affect conditions and treatment, from having a physical therapist treat an injured shoulder, treating bladder problems, middle ear infections, lung and chest conditions, and more.
Pre-existing health conditions and ailments are often excluded from your policy because health insurance is designed to treat new conditions that occur after your coverage has begun. After all, insurance is about unforeseen or unexpected risks rather than the insurer paying right away for something that happened before the coverage was in force.
To verify any pre-existing conditions, health insurers may require a medical history beforehand or apply a fixed exclusion.
Health insurance policies in the UK will not normally cover chronic conditions that are classified as ongoing, require long-term treatment, have no cure or are likely to return.
This could be recurrent heart or lung problems, kidney dialysis, or cancers.
Health insurance is designed to pay for treatment to return you to original health, and if something is ongoing and likely to affect you long-term, they usually can’t cover it. but there may be circumstances where a chronic condition has a sudden short-term deterioration, which can be treated to return you to your previous state of health which insurers may consider depending on the circumstances.
Routine dental treatment is usually covered by a separate dental insurance add-on or cash plan, rather than your health insurance.
however, this is not always the case. You may be entitled to coverage for certain specialized dental surgery, while a dental insurance add-on or cash health plan may allow you to claim up to a certain amount of cash each year for routine dental check-ups, appointments with a hygienist and fillers.
however, cosmetic dentistry, such as braces, teeth whitening, or veneers, is typically not covered by your standard pmi.
Outpatient prescription drugs are usually not covered by your private health insurance, but it may depend on whether you are receiving other private treatment at the time and the drugs are prescribed by the specialist in charge of your treatment at the hospital. In this case, it’s worth checking the terms of your policy and what coverage you get as an outpatient.
Cosmetic surgeries are considered lifestyle choices or “elective treatments” rather
that out of necessity and therefore are not covered by health insurance policies. this includes cosmetic treatments like nose jobs (rhinoplasty), breast implants, botox, face lifts, and anything cosmetic.
However, some reconstructive surgeries may be covered by insurance after an accident and to treat a short-term curable condition that would otherwise be covered.
Always check the terms and conditions of your policy.
there are a number of general exclusions commonly found in the policies of major uk health insurers, which may be because they meet some of the criteria discussed, such as being chronic, long term, cosmetic or otherwise there are cures available. , this includes:
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