Did you know that cosmetic treatments, health problems related to risky activities, traffic accidents, etc. are not included in these policies? In some cases, you may be familiar with them, such as pre-existing conditions, but these cases are also excluded from your coverage.

Health insurance offers comprehensive medical coverage and access to a wide range of preventive services. In the interest of transparency, we are going to focus on the most common risks excluded from these contracts.

The global awareness of the importance of health-related issues is now more relevant than ever. Many families choose to take out insurance to protect what matters most because of its many advantages: access to a wide range of medical services, shorter waiting times for tests and consultations, and additional amenities in the event of hospitalization, among others. The benefits are becoming increasingly comprehensive.

Now, here are some of the risks that are generally excluded from these insurance policies, because knowing what is not covered is just as important as knowing what your health insurance covers, if not more so. In addition, there are certain situations in which there are limitations on use or they are not effective for a certain period of time.

What you need to keep in mind: exclusions, limitations, and waiting periods

To be clear, exclusions are illnesses, diagnoses, treatments, or physical conditions not covered by your policy. This is a common feature of all private health insurance policies. Your insurer will therefore not provide protection in these cases.

Another thing to keep in mind is that there may also be limitations on certain services. For example, in the case of podiatry or psychology, most of these insurance policies include a maximum number of sessions per year.

We should also not confuse exclusions with waiting periods, i.e., the period of time that must elapse from the signing of the contract until you can access certain benefits of the policy. The clearest example is births.

Most insurers have a waiting period of between six and ten months.

The most common cases

Although there are significant similarities, each insurer decides which limitations, waiting periods, and exclusions to include in its products, which may vary between its own policies. In any case, they must be clearly identified in the contract and communicated to the customer in a clear and understandable manner before signing the policy. Below, we highlight the most common exclusions in health insurance: 

1. Pre-existing conditions. In general, these policies exclude pre-existing conditions, i.e., illnesses or health problems that the insured already had before taking out the insurance. It is essential to be completely transparent when filling out the pre-insurance health questionnaire because, if we conceal medical information, the policy may be canceled.

2. Cosmetic treatments. They also do not usually cover cosmetic treatments or plastic surgery that is not medically necessary. For example, if you want to improve the appearance of your nose (rhinoplasty), the operation will not be covered unless it is to repair a breathing problem. Likewise, they do not usually include refractive surgery to correct vision problems such as nearsightedness, farsightedness, or astigmatism, although they may offer discounts at affiliated clinics.

3. High-risk activities. If you practice extreme or dangerous sports, your insurance will not normally cover medical expenses for accidents or illnesses related to these activities. This is the case if you are injured while skydiving. On the other hand, war and terrorist acts are also usually excluded from coverage.

4. Workplace or traffic accidents. Similarly, illnesses and injuries resulting from workplace or traffic accidents are not included, as they are covered by other insurance policies.

5. Experimental or alternative treatments. Treatments involving certain alternative or experimental therapies are another common exclusion, meaning your health insurance will not cover these expenses. However, you may be able to access them at special prices as a customer. 

6.  Transplants. Some types of transplants may be excluded, while others, such as bone marrow and cornea transplants, may be included. Read the contract carefully.

7. Medications. These policies cover medications that must be administered in their clinics or hospitals. Prescriptions for medications are always paid for by the insured.  

How to choose health insurance?

Each insurance company decides what to exclude from the health insurance policies they offer their customers. However, in all cases, these situations must be clearly specified in the policy conditions.

If you have decided to take out this type of insurance, first think about what you really need: just medical consultations, hospitalization, specific treatments, etc. Being clear about your priorities will help you filter the options.

Take a look at the coverage and, as we have seen, the exclusions, limitations, and waiting periods to avoid unpleasant surprises. If you have any questions or need more information, consult our experts. At Mapfre, we offer a comprehensive range of products so you can choose the best health insurance for you and your family.