Exclusions: the need to know

Exclusions: the elephant in the room

You and I both know that health insurance policies – regardless of how wonderful and comprehensive they seem – always come with a long list of exclusions. This can be in the form of specific treatments that are not included in your policy, time-related restrictions and various limitations. With that in mind, it’s important to always go into your policy knowing the limitations of your health insurance coverage so that you are not caught off guard during a medical emergency. There are other types of medical cover you can buy to protect yourself against critical illnesses or against items that are excluded from a typical health insurance policy in the UAE.

Undeclared pre-existing conditions

Before an insurance company approves you for a plan, you have to fill out a questionnaire about your medical history. There are no ifs, ands, or buts about it – if you forget to mention a condition, whether accidently or purposely, the insurance company can actually void any claims you have made and exclude all benefits from your policy.

Many UAE residents misinterpret the definition of a pre-existing condition; it is actually a condition that existed before you purchased the medical insurance policy, whether or not you knew about it. The insurance company decides whether the condition existed before or after your policy cover started. So even though you may not have known about a specific condition, if it was diagnosed shortly after you bought health insurance and the insurer decides it was a pre-existing illness, it may be excluded.

Waiting period

This is a time-related exclusion where you can not make any claims related to a policy benefit until after a certain time period has passed. The most common types of waiting periods for insurance plans in the UAE are related to pre-existing conditions and maternity. Before making a claim related to pregnancy, there is typically a waiting period of up to 12 months.

From the insurers’ perspective, this prevents a couple from buying medical cover, after finding out they are having a child, just to pay for the maternity costs (a losing proposition for the health insurance company). Dental benefits may also have a waiting period which is usually around 6 months.

Specific charges

When someone is hospitalized, there is a long list of charges and fees related to the hospital stay. It is not simply a matter of paying for a hospital room, there are also fees associated with registration, admission, nursing care, food, medical supplies, lab tests, etc. Similarly, during a surgery, there are a wide range of costs such as operating theatre charges, anesthetist fees, nursing and scans – in addition to surgeon, specialist & consultant fees.

In some cases, the health insurance company will not pay for a specific fee. For example, many insurers will not cover any registration or admission charges on the hospital bill. However, they will cover the main costs such as the hospital room, lab tests, nursing and doctor consultations. Other items that may be excluded may include food & drinks, roll-in beds, telephone calls or internet.

Excluded treatments & conditions

Every health insurance plan also includes a lengthy list of specific treatments or conditions that fall under exclusions. Common items are plastic surgery, hearing loss, vision aids, obesity, drug abuse, infertility, impotence and skin disorders.

Hospital & clinic exclusions

Last but not least, certain hospitals & clinics may be excluded from your health insurance policy. In some of the cheaper health insurance plans in the UAE, there could be more general exclusions such as being required to go to a clinic (instead of a hospital) for any out-patient service.

It is easy to distrust insurance companies because of all these terms & conditions. However, at the end of the day, you need to buy health insurance to protect yourself, and the insurer needs to make a profit. It is extremely important that you compare health insurance in the UAE to find the best plan for your needs. Exclusions are a part of life when it comes to medical cover, but that does not mean you can’t find a great plan for yourself.

Related articles:

Dubai Health Insurance Law: What You Need to Know

Understand How Hospital Accommodation is Covered in Your Health Insurance Plan

What to Know Before You Buy Health Insurance