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When it comes to health insurance, one of the most important aspects to consider is what is and isn't covered. Unfortunately, many things aren't typically covered by health insurance policies, which can be a significant inconvenience. 

In this blog post, we'll also discuss some potential consequences of not having health insurance coverage for these expenses. So if you need clarification on whether or not your insurance policy covers a particular expense, read through this blog post!

Things That Are Not Covered Under Group Medical Health Insurance 

Group health insurance may be a good option for you if you're looking for health insurance. However, it does not cover various treatment and medical expenses. It's also essential to know each plan's benefits and exclusions to make an informed decision. Additionally, be aware that group health insurance policies vary from plan to plan, so it's essential to read the fine print before enrolling. Ask questions and get clarification if you have any doubts about coverage. Finally, be aware of exclusions - things typically not covered by group health insurance policies. This can include pre-existing conditions, for example, or health insurance policies not affiliated with a group health plan. 

Cosmetic Surgery 

Regarding group health insurance, coverage for cosmetic surgery is only sometimes guaranteed. That said, there are a few types of insurance that do cover cosmetic surgery. You must ask your insurer if you need clarification on whether your coverage includes this procedure. Some specific procedures may be considered preventative care and won't be covered. Additionally, it's essential to be aware of the costs associated with cosmetic surgery before making a decision. There are many ways to get cosmetic surgery without going through expensive out-of-pocket expenses. For example, you can look into insurance plans that cover a fraction of the cost of surgery. So, whether you're looking to get a facelift, fix your nose, or improve your appearance in some other way, group health insurance might be a good fit for you. 

Pre-existing Diseases 

If you want health insurance, be aware that pre-existing conditions are not always covered. If an insurer finds out that you have a pre-existing condition, they may deny your policy or charge higher premiums. Knowing the ins and outs of group health insurance beforehand is vital, so you're aware of it. If you're employed by a company/organisation that offers group health insurance, speak with your department head or human resources representative to see if it's a good fit for you. Group health insurance can be a great way to cover medical expenses without worrying about costs. 


Pregnancy and Abortion 

Group health insurance typically doesn't cover pregnancy or abortion. If you need coverage for either of these events, you'll need to purchase an additional policy or find a plan that offers these services separately. Keep in mind that abortion is not typically covered, although there may be exceptions depending on the policy.

Diagnostics Expenses 

If you're thinking of getting group health insurance, be sure to read the small print. Most policies don't cover diagnostic expenses, like doctor visits and tests. This can be a huge financial burden if you need to take these services. If you need them, discuss the costs with your healthcare provider before making an appointment. Additionally, be aware of any exclusions or limitations in your policy. Once you have all the information, it's time to decide if group health insurance is right for you! 

Miscellaneous Charges 

Group health insurance plans typically cover a variety of health-related expenses, such as doctor visits, lab tests, and medications. However, several charges are not typically covered by these plans. These charges can include fees for doctor visits, lab tests, and drugs. It's essential to be aware of these BEFORE signing up for coverage. If you have any questions about your plan or other related matters, don't hesitate to contact the insurer or your healthcare provider(s). 

Health Supplements 

Group health insurance typically does not cover health supplements. This is because health supplements are not generally regulated/come under the Food and Drug Administration (FDA). As a result, many health supplements may contain unsafe or unproven ingredients. Additionally, health supplements are not typically monitored for side effects the same way that medications are. This means a higher risk of taking a health supplement that may have adverse effects.


Infertility/Pregnancy-related complications 

When planning a pregnancy, it is essential to know what group health insurance plans typically do and don't cover when it comes to infertility and pregnancy-related complications. Infertility and pregnancy-related complications are not typically covered under group health insurance plans, which can financially burden couples. If fertility treatments or other services are required, they may be considered medically necessary treatment under the plan's definition of "medically necessary." You must speak with a healthcare professional to determine if infertility or pregnancy-related complications are covered under your policy. Read your policy document's exclusions and limitations section for more information on what is and isn't covered! 

Diseases related to Overconsumption of Alcohol 

Group medical health insurance is a great way to protect your employees from various health problems. However, alcoholism can lead to several health problems not covered by group health insurance. These include cirrhosis, pancreatitis, and liver cancer. It's essential to be aware of these diseases to get the care you need if they arise. Speak with your insurance company about what is and isn't covered to ensure you're fully protected. In the meantime, remember to take care of yourself and drink responsibly! 

Expenses incurred on Alternative Therapies 

This includes treatments like homoeopathy, naturopathy, and acupuncture. However, finding a policy that will consist of these treatments can take time and effort. If you need help finding coverage, speak with a representative from your group health plan or an insurance agent. Additionally, qualified professionals should be consulted before making any changes to your healthcare regimen. 

List of non-medical expenses as per IRDAI guidelines 

Group medical health insurance is a great way to provide health insurance coverage for a group of people. However, it could be better. One common issue is that it only covers several expenses that individuals might be able to cover under their health insurance plan. This IRDAI document comprehensively lists expenses not covered under group health insurance policies. 

These include transportation costs, vacation expenses, and any other out-of-pocket expenses. It is essential to read the plan carefully before selecting one to know exactly what's covered and what isn't. If you're interested in purchasing group health insurance for your employees or family members, speak with a licensed agent. 

Optional items 

1. A few optional items must be covered under group health insurance policies. This could include maternity leave, adoption fees, travel expenses, etcetera. 

2. To find out if you're covered and plan on taking any out-of-policy expenses, it is best to speak to an insurance agent who can help identify the coverage you need and point you in the right direction for finding the best policy for your unique needs. 

3. Always read your policy document carefully before signing up - hidden costs might need to be highlighted when shopping around.

Non-medical expenses in treatment cost 

When you are undergoing treatment, the expenses mentioned in this article will be high costs that you will have to cover yourself. The expenses include: 

1. Travel and living expenses while on leave from work 

2. Hospitalisation costs 

3. Medical negligence fees 

4. Funeral expenses 

5. Rehabilitation costs and mental health treatment, etc 


Non-medical expenses in the room charges 

Room charges like telephone, tea, water, electricity and internet are not covered under group health insurance. Travel expenses incurred for medical treatment are also not covered by the policy. If you want them hidden, you must make a separate arrangement for these costs. 

Non-medical expenses in procedure costs 

There are various expenses you may incur while undergoing a medical procedure. Consult your insurance provider to determine whether you are covered for all the costs. Some of the expenses that can be billed as non-medical expenses include travel for medical reasons, consultations and investigations, and other related costs such as transportation or accommodation. It is also essential to have all required documents ready in advance, so there's no delay in starting treatment. Finally, inform your health insurer about your plan so they can adequately process the claim. 

Other non-payable medical expenses 

There are a few expenses that group health insurance policies don't usually cover, such as hospitalisation expenses, medications and treatments not covered by the policy, funeral and burial expenses etc. These can get pretty expensive if you have to incur them without coverage. So make sure you know what's included under your plan, so you're aware of the situation! 


Some things are not typically covered by insurance, such as cosmetic surgery and pre-existing diseases. Be sure to speak to your insurance provider if you are concerned about anything that may not be covered. They should be able to help you understand the coverage that is available to you.