Health Insurance Exclusions: Know What is Not Covered

By Laxita Gautam
  | Published: 19 July 2021

Don’t gamble with your health, get the right cover at the right price.

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Reading each term and condition of your health insurance plan is easier said than done. The more comprehensive your plan, the harder it will be to get familiar with each inclusion, exclusion, add-ons and additional term in it. But regardless of the hard work that it demands, you need to understand the making and breaking of your health insurance plans. Now, the good thing is that most insurance companies list inclusions of the plan in bold letters on the initial pages. It is the health insurance exclusions that most plan holders are not aware of or miss out on. But just like any other country and city, medical insurance in Dubai also has its limitations and will not cover every single condition, treatment or illness. These uncovered things are typically referred to as health insurance exclusions.

What are Health Insurance Exclusions?

Exclusions are simply the expenses, fees and benefits that the insurance company does not cover. These health insurance exclusions are generally listed in your health insurance contract as well. But the list is often too long to be examined in detail no matter how many times one hears people preaching to read the fine print. Although every insurance provider is different and may have a vast difference in terms of the benefits that their plans offer, the list of health insurance exclusions often remains the same, with only a few changes to show for. Either way, it is always better to know what is covered and what is not covered before you even set out to choose a plan to avoid disappointments.

Common Health Insurance Exclusions in Medical Insurance Dubai

Self-Inflicted Injuries or Suicide

Almost any health insurance or even travel insurance does not cover the cost of treatment that is to be received because of self-inflicted injuries. This includes the hospitalisation costs, prescription medicines and even pre-hospitalisation services like an ambulance. Any expense that rises due to suicide is also not covered by the health insurance company. That includes death benefits and repatriation expenses as well.

Injuries or Illnesses Involving Illegal Activities

Health insurance plans cover almost all cases of accidental injuries. However, if these accidental injuries were caused due to involvement in illegal activity, the insurance company will not cover for them. This applies even when you are travelling out in a foreign country and planning to use the worldwide coverage facility of the insurance company.

Undeclared Pre-Existing Health Conditions

Every insurance company urges their customers to provide a complete and honest account of their health conditions and lifestyle habits. Many comply with this, understanding the importance of this exercise while many others do not. The same is the case with pre-existing health conditions. The premium of an insurance policy increases if pre-existing conditions are declared in the forms. But this also means that any treatment requirements arising from these conditions would be covered by the company. However, if a claim is made for a pre-existing health condition that was undeclared, the company will not cover it.

A Few Fees or Charges on Covered Benefits

The basic benefits list of an insurance company would say that the hospitalisation costs for a covered illness will be paid off by the insurance company. However, several small fees or charges still go out of the pocket of the plan holder. These charges can include registration fees and admission charges, additional services like internet, roll-in beds, food and drinks, calls, etc. The insurance plan will still cover the major costs of hospitalisation like bed, room consultations, etc., but the smaller fee may have to be paid by you, the plan holder.

Injuries or Illnesses from Hazardous Activities

Any injuries that are caused by potential and pre-declared hazardous activities are not covered by the insurance plans. This can include the simplest things like horseback riding and the most complex ones like flying a plane. The list of these hazardous activities can also differ from one insurance provider to another.

Adventure Sports and Athletics Injuries

Unless specified by the insurance provider and the plan, adventure sports and professional sports injuries are not covered under any health insurance plan. Some plans are made specifically to cover these activities, so this exclusion will not apply when those plans are concerned.

Injuries from Conflicts, War or Terrorism

All health insurance plans will have this exclusion in them. Any disease or injury caused due to an act of terrorism, war and conflicts is not covered for treatment by the company. This will include all related secondary services as well which are taken about these injuries.

Natural Disaster Caused Injuries

Treatment costs for injuries caused when a natural disaster strikes are not paid by the insurance company. This particular exclusion is listed in the exclusion as an ‘act of God’ at times. So, if you happen to stumble upon it when reading the health insurance exclusions, know that the ‘act of God’ portion is actually about natural disasters.

Injuries Caused in Military Training or Activities

The training regiments for military personnel are often intense and even dangerous. Even though there is a good enough chance that one may incur an injury when undergoing military training, most health insurance plans do not cover their treatments and expenses.

Medically Optional Treatments

Every health insurance plan in the UAE will only cover the treatment that has been deemed necessary by the treating doctor. Any non-essential or optional treatments are not covered. This applies even in the case of illnesses that are specifically stated as covered in the insurance plan. You are generally required to obtain a medical record or statement from your doctor when filing a claim. This statement must include the declaration from the doctor that the treatment you are getting claimed for was indeed necessary for the condition and not optional or else, the claims are denied.

Additional Health Insurance Exclusions of Medical Insurance in Dubai

The aforementioned health insurance exclusions are a part of almost every health insurance plan available in the UAE. Although several other health insurance exclusions can be a part of medical insurance in Dubai, their existence depends on the plan and the provider as well as the add-on services available with the provider.

Dental and Optical Treatments

The basic benefits of a health insurance plan seldom contain dental and optical treatments. Often, there are add-ons available for these treatments and several comprehensive health insurance plans may also include them. But for the majority of health insurance plans, these are regarded as health insurance exclusions except for cataract surgery, which comes under medically necessary treatment for the condition

Cosmetic Surgeries and Treatments

All kinds of cosmetic surgeries are regarded as health insurance exclusions in every medical insurance in Dubai. This can include implant surgeries and other kinds of plastic surgeries for a facelift, deviated septum, etc

Obesity Treatments and Surgeries

All kinds of weight reduction therapies, treatments and surgeries are excluded from health insurance coverage. They are regarded as non-essential treatments in most scenarios.

Experimental and Research-Related Treatments

Medical treatments that are yet to be proven as one of the essential and effective treatments for a disease or condition, or the treatments that are still in trial phases are not covered by health insurance in the UAE. This includes medicines, surgeries and therapies.

Treatment and Services Received from Unauthorised Providers

All your treatments, consultations and medications are to be received from a recognised clinic, hospital, doctor or provider. The doctor must provide their medical license for you to claim a specific treatment. Any services availed from an unlicensed provider are not covered by health insurance.

Fertility-Related Treatments

All fertility-related treatments and alternative therapies are included as health insurance exclusions in medical insurance in Dubai. This includes prescription medications to increase fertility for both men and women and the In-Vitro Fertilization technique to conceive.

Prosthetics and Other Aids

All kinds of prosthetic aids are excluded from insurance plan coverage. This also includes hearing aids and visual aids for the betterment of both the senses.

Growth Hormone Therapy and Immunotherapy

Any vaccinations and medicines taken as growth hormone therapy or for strengthening the immune system are seen as an exclusion in health insurance plans.

Contraception

The exclusion of contraception includes everyday pills, sterility treatments like vasectomy and other forms like copper-T.

Chiropractic Therapy and Services

All kinds of chiropractic therapies are excluded from most health insurance plans. Some surgeries may be included for similar conditions; however, it depends on the insurance providers.

Alternative Medicines

All forms of alternative medicines are excluded from every health insurance plan coverage. This includes Ayurveda, homoeopathy, aromatherapy, ozone therapies, massage therapy, acupuncture, hypnosis, etc.

Conclusion

No matter how comprehensive your health insurance plan is, there are always going to be a few health insurance exclusions in its coverage. There is no health insurance plan in the UAE or the world that covers absolutely everything. However, this does not mean that you are paying the premium for nothing. Almost all of your health insurance plans will provide you with the cover that they promise at the time of buying the plan. You just have to make sure that you have read and understood every inclusion and exclusion in the plan to avoid problems and disappointments when it is time to file the claim.

Laxita Gautam
Laxita Gautam63 Posts

Senior Content Writer | She functions on classic British fiction, Japanese manga, and strong americanos. Laxita is tailor-made to create engaging, interactive pieces that offer simplified insights into complex subjects.