Understanding the Exclusions of Your Medical Policy

Insurance Policy Agreement Terms Document Concept

Having medical coverage doesn’t mean that you will get coverage for all health and wellness issues. Before you invest in health insurance, you must understand that medical insurance covers illness and not wellness, unless it is specifically added to your policy. In the real world, no health insurance plan covers every medical condition regardless of how expensive the policy is.

Insurers in the UAE follow a common exclusion list regulated by Dubai Health Authority (DHA). These exclusions can be in the form of certain treatments, time-related restrictions, and various limitations.

This guide will help you understand the exclusions of a medical policy in detail.

Undeclared Pre-existing Conditions

Basic health insurance can cover pre-existing conditions. If a health plan does cover pre-existing conditions declared in the form, you will pay an increased amount of premium. However, any claim made for undeclared pre-existing conditions will not be covered.

Health Supplements

Supplements are often prescribed to replenish nutrients in your body. They don’t come under the purview of medicines essentially required to treat illnesses. Your insurance provider will not cover over-the-counter supplement purchases. However, if your doctor deems a health supplement to be necessary and prescribes it to you, then its cost might be covered by your insurer. One classic example is vitamin D which is covered only when deficiency is justified by your doctor.

Cosmetic Treatments

All kinds of cosmetic treatments and surgeries are regarded as exclusions in every medical insurance policy in the UAE. It includes facelift, deviated septum, implant surgeries, eyelid surgeries, and so on.

Dental and Optical Treatments

Basic health insurance plans generally exclude dental and optical treatments from their coverage. If you want these treatments to be covered, most insurers can cover them in exchange for an additional premium. However, some comprehensive health insurance plans may include them. Cataract surgery might be an exception as it comes under medically necessary treatment.

Alternative Treatment Practices

If you are someone who prefers alternative treatments, you must know that some alternative medicines and treatments are included in all health insurance policies. This includes Ayurveda and Homeopathy. Others such as Aromatherapy, Massage Therapy, Acupuncture, Hypnosis, etc. are exclusions. Besides that, chiropractic therapies are also excluded from most health insurance plans.

Treatments for Fertility Issues

Any fertility treatment for men and women is not covered under health insurance policies in the UAE. Hence, fertility prescription medications and in-vitro fertilization treatments are excluded as well.

Treatments for Weight Loss and Obesity

All kinds of treatments required for weight reduction are regarded as non-essential treatments in most cases. Thus, they also go under general exclusion from a medical policy.

Treatments for Certain Injuries

Most medical insurance policies don’t cover the expense of treatment for injuries caused by the following reasons:

  • Self-Harm, Conflicts, War, and Terrorism: No health insurance and even travel insurance will cover the cost of treatments that are received for injuries inflicted by self or caused by other reasons, such as acts of terrorism, war, and conflicts.
  • Natural Disasters: Injuries caused by natural disasters are also listed under the exclusion as ‘an act of God’.
  • Adventure and Professional Sports: Most medical policies exclude adventure sports and professional sports injuries; however, you can find some insurance policies designed specifically to cover such injuries.
  • Hazardous Activities: Injuries and illnesses sustained from hazardous activities, such as horseback riding and flying a plane, also fall under exclusions.
  • Accidents that involve illegal activity: Even though most health insurance plans cover almost all accidental injuries, they will not cover the expense if accidental injuries were caused due to involvement in illegal activity.
  • Military Training: The training for military training is extremely rigorous and can be even dangerous. Still, most health insurance plans do not cover any injury caused by military training.

Optional Medical Treatments

All health insurance providers offer coverage for expenses for only the treatments that are deemed absolutely essential by your doctor. Any non-essential and optional medical treatments fall out of the scope of your medical coverage. This applies even to the illnesses specifically mentioned and covered in the medical policy. Before a claim is approved, you are required to provide a medical record or statement from your doctor that declares that the treatment you are getting is indeed necessary and not optional. Otherwise, the medical claim will be denied for sure.

Apart from these, there are also other exclusions, such as growth hormone therapy, immunotherapy, contraception, prosthetics and other similar aids, and treatments and services received from healthcare providers outside of the network of your insurer.

After seeing this long list of exclusions, you might think that investing in health insurance is not worth it. On the contrary, there are still so many benefits of having a health insurance policy that will protect you from the rising healthcare costs in the UAE.

It is extremely important and even mandated by the UAE government for every resident to have at least a basic health insurance plan. Even if there are exclusions in every medical policy, you can still find a great health insurance plan with the help of a dedicated health insurance broker.

At New Age Insurance Brokers, we strive to help our clients choose the best health insurance plans for themselves and their families. Your financial security, happiness, and optimum health are our priorities. So, before you make the final decision, get in touch with us to find a health insurance plan that best serves your medical needs.