What are exclusions in health insurance?

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July 11, 2023
4
minutes read time

The UK health insurance market offers many different types of policies for individuals, couples, families, and businesses who are looking for private cover. However, it’s important to note that not all medical treatments, conditions, or services are covered by health insurance policies.

Known as health insurance exclusions, these are specific terms in your policy that exclude medical treatments and services from your coverage. We’ve covered what exclusions are, why they exist, some common examples, and how we can help you understand which exclusions would apply to your policy.

Health insurance exclusions: What to expect

Health insurance exclusions are in place to help providers manage their costs and protect themselves against the high charges of treatment costs that would result in higher premiums for customers buying policies. They help providers and policyholders understand precisely what they’re covered for and cannot claim for. 

Health insurance policies range from basic to comprehensive cover. Regardless of your choice, there will always be exclusions in place, but you will find that more basic policies have more exclusions to help keep the cost down for policyholders.

Examples of common exclusions

Exclusions vary from provider to provider and person to person. Some exclusions will be commonplace across every policy, while others may be excluded due to your policy level or unique circumstances. You may be able to add cover for treatments and services that would be otherwise excluded, but this is handled on a case-by-case 

To help you understand what may be excluded, we’ve listed some of the common exclusions that you may find when comparing health insurance policies available in the UK.

  1. Pre-existing conditions - If you’ve previously suffered from a medical illness, you may find that any related treatments services are automatically excluded. Some providers may offer you cover if the illness is minor and unlikely to reoccur, but you may not have this option available to you.

  2. Outpatient cover - Outpatient treatments are those where you’re required to stay in the hospital overnight. Some policies will not include this as standard, but you may often find the option to add the cover.

  3. Cosmetic procedures - Aesthetic surgeries that you elect for yourself are commonly excluded as there is no medical need for the treatment to take place. This may include but is not limited to liposuction, facelifts, breast augmentation, and otoplasty.

  4. Self-inflicted injuries - Health insurance policies will commonly exclude cover for injuries that have been self-inflicted, including those as a result of substance abuse.

  5. Experimental treatments - Some new or experimental treatments may not be included in your cover. This may be because the treatment isn’t yet approved, the results aren’t established, or they’re currently too costly for providers to cover.

  6. Fertility treatments - Treatments such as in vitro fertilisation (IVF) and related treatments may be excluded from your policy or available through some providers for an additional premium.

  7. Alternative therapies - Therapies such as acupuncture, homeopathy, and naturopathy may be available to cover for an additional cost, but they aren’t commonly included in basic health insurance policies.

  8. Waiting periods - Some policies may include a waiting period for conditions or treatments you’ll need to complete before you’re eligible to receive the treatment as part of your cover.

  9. Dental and optical cover - Dental and optical cover may be excluded from your policy, but it is available across many providers as a policy add-on for an increased premium.

  10. Sports-related injuries - If you require medical assistance as a result of playing sports or taking part in high-risk activities, your provider may exclude you from receiving any cover as you took on the risk when participating in the activity.

  11. Mental health - Mental health cover may be becoming more commonplace in policies, but some providers won’t include related treatments as standard. In these cases, you may be able to include mental health cover as a policy add-on.

  12. War or acts of terrorism - Health insurance policies may exclude coverage for injuries and illnesses that are caused by acts of war or terrorism due to the unpredictable nature of these events and the high costs they would pass on to providers.

  13. Chronic conditions - Health insurance intends to cover acute medical conditions. Chronic conditions are considered to be incurable, long lasting conditions, and they’re commonly excluded from health insurance policies.

  14. Pregnancy - While many health insurance policies offer coverage for maternity and childbirth, some may have specific exclusions or waiting periods for many pregnancy related treatments and services.

  15. Weightloss programs - Health insurance policies may exclude coverage for weight loss programs or services like dietary counselling, gym memberships, or weight loss medications. These exclusions aim to distinguish between weight loss for medical reasons and weight management for general wellness.

  16. Non approved facilities - Some health insurance policies may only cover treatments and services provided by specific providers in specific facilities. Receiving treatment outside of this network is excluded.

  17. Organ transplant expenses - Health insurance policies may have limitations or exclusions on coverage for organ transplantation. This can include costs associated with the transplant procedure itself, immunosuppressant medications, and post-transplant care.

Equity Health: Helping you understand health insurance exclusions

Understanding health insurance exclusions can be complex, time-consuming, and challenging to compare across multiple providers. 

As an independent broker working with many UK providers, we’re committed to helping individuals understand their options and compare policies. We aim to learn about all of your wants and needs before searching the market for the policy that offers you the highest level of coverage at the most competitive cost.

We offer this as a free service, and you’re not obligated to purchase any of the policies we present. Every conversation we have with individuals looking for health insurance is different, and we offer a personalised experience from your very first question through to renewing your policy in the future.

To help understand health insurance exclusions or anything related to private medical insurance, please complete the form below, and we’ll contact you.

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