Elevate leads - on a genuine split.

A Longer Wait For BP, Sugar And Heart

Some policies set a second, longer initial waiting period for hypertension, diabetes and cardiac conditions, on top of the usual 30-day wait that applies to every illness. If one of those three conditions is treated before the longer period ends, the insurer does not pay, and you pay the hospital bill from your own pocket. The wait is counted from the first policy start date. Where a policy re-applies the wait to a later increase in Sum Insured, its own wording says so.

Consumables And Non-Medical Items

Consumables and convenience items on the regulator's non-medical lists - gloves, admission kits, toiletries and similar - are struck off the hospital bill, and that part stays with you unless the policy writes them back into cover. On a long stay these small lines add up to real money.

Doctor Visits And Medicines Without Admission

Health insurance normally pays only when you are admitted to a hospital. Treatment taken as an out-patient - a doctor's consultation, medicines bought on a prescription, a test or a scan taken without being admitted - is excluded unless the policy grants an out-patient benefit of its own. If the policy grants no such benefit, you pay every out-patient bill from your own pocket.

External Medical Devices

A device you can put on and take off yourself, without a surgery to fit it, counts as equipment rather than as treatment, and is not paid for. Each policy draws the line in its own words: some list the items, such as wheelchairs, walkers, crutches, glucometers, oxygen concentrators and machines for sleep apnoea, and others set a test, such as whether the device can be removed without surgery. Where a policy writes a way in, either inside the clause or through an add-on that names the items it will pay for, its own wording says so.

Therapies Outside AYUSH

Systems of medicine a policy does not recognise are not paid for. Where the policy grants an AYUSH benefit, that benefit covers Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy, and it overrides this clause as far as it reaches. Therapies outside those six - acupressure, acupuncture, magnetic therapy, reflexology, chiropractic - stay excluded, and each policy names its own.

Organ Donor Costs

The costs that sit around an organ donation, both finding and screening a possible donor and the expenses the insured person runs up in donating, are not paid as ordinary treatment. A donor’s own treatment is paid only as far as a policy’s organ-donor benefit reaches, and whatever that benefit leaves out stays with you. The clause quoted for each policy tells you which of these costs its own wording removes.

Sexually Transmitted Infections

Sexually transmitted infections are excluded by name - for example genital warts, syphilis, gonorrhoea, genital herpes, chlamydia, pubic lice and trichomoniasis. Some policies write HIV/AIDS out of this exclusion and keep it covered; the clause quoted for each policy tells you which.

TV And Toiletries

Admissions And Charges Judged Unnecessary

The insurer can refuse an admission it judges was not medically needed - and, where the policy's own wording says so, any charge it judges above the going rate. It is the widest discretion in a policy and it applies to every claim, so keep the treating doctor's reasons on the file.

Admissions For Recovery, Not Treatment

An admission for recovery rather than active treatment is not paid. Each policy extends the clause in its own direction: some add general weakness, a run-down condition or a nutritional deficiency, others add sanatorium stays, private duty nursing and long-term or custodial care. The clause quoted for each policy tells you which. It costs the most when an elderly patient is kept in hospital after the acute treatment has finished.

Advanced Procedures Excluded By Name

A set of advanced procedures is excluded by exact name - high-technology treatments the policy will not pay for even though hospitals offer them. Before you agree to a procedure with a brand-style name, check that name against the policy's own list.

Anything Treatable Without Being Admitted

If the treatment could reasonably have been given without admitting you, the claim is refused - even though you were admitted. This is one of the most common reasons a hospital bill goes unpaid.

Expensive Drug Infusions

Expensive drug infusions, biologics most of all, are handled separately from ordinary hospital treatment. Some policies pay for them only when you are admitted, and refuse the same drug given in an outpatient infusion chair. Others refuse the admission that was arranged so that the infusion could be given, and a clause may name other costly infusions alongside, such as immunoglobulin or bone-strengthening drugs. Either way a large cost, often a repeated one, stays with you. The clause quoted for each policy tells you which way its own wording runs.

Injections Into A Joint

Injections given into a joint, and the platelet-rich plasma and cartilage treatments offered for knee and joint pain, are excluded. Some clauses bar the treatment itself. Others bar only the admission that was arranged so that the injection could be given, and some reach wider, to an injection into a lesion or to the medicines infused alongside it. The clause quoted for each policy tells you which, and names the injections it means.

Untested Therapies

Vaccinations