Health Insurance Plans – Exclusions Explained

When taking out a health insurance plan in Singapore, and in most countries, be aware that there will be certain health issues that are not included in a standard policy. We look at what the common insurance exclusions are and how to make sure you cover what’s important to you, through supplemental insurance or riders.

What’s Not Included in Health Insurance Plans

What are insurance exclusions?

Most insurers choose not to cover treatments they consider medically unnecessary. An exclusion is a provision that eliminates coverage for certain treatments, conditions and other items. Details and conditions typically vary for each provider. There will be various reasons why insurers won’t cover these treatments or situations, and different insurer have different policies on these exclusions. When buying a health insurance plan, make sure you read the terms and conditions to determine what is covered and what isn’t.

What are common exclusions in health insurance plans in Singapore?

8 common health insurance exclusions

#1 Pre-existing conditions

Pre-existing conditions are medical conditions that an individual has before obtaining health insurance, such as heart disease or other chronic conditions.

#2 Behavioural and personality disorders

#3 Maternity coverage and fertility treatments

Health insurance plans usually exclude maternity coverage and fertility treatments for women, with maternity coverage offered as an optional rider or separate plan. Maternity coverage includes prenatal and postnatal visits and childbirth. Treatments like in vitro fertilization (IVF) and other assisted reproductive technology (ART) will also generally not be covered.

Allianz Care and VUMI are international health insurance providers that offer fertility treatment in their more comprehensive plans. For more information, read this Pacific Prime blog post.

#4 Alternative medicine and therapies

Alternative medicine and therapies, such as homeopathy, naturopathy, reflexology, energy healing and acupuncture and chiropractic visits, may not be included in your health insurance plan. In Asia some policies include coverage for Chinese Traditional Medicine (CTM).

#5 Self-inflicted and extreme sports injuries

If injuries are seen as self-inflicted through extreme sports, substance abuse or a suicide attempt, many insurance plans do not provide cover.

Extreme sports includes but is not limited to skydiving, rock climbing, zip-lining and mountaineering. If needed, look for health insurance policies that offer optional extreme sports riders to cover these activities.

#6 Cosmetic surgery

Cover does not include medically unnecessary procedures such as cosmetic surgery. This is because these are seen to be done with the sole purpose of enhancing someone’s features.

Examples of cosmetic surgery and treatments not covered by insurance include:

• Abdominoplasty (“tummy tuck”)
• Liposuction
• Rhinoplasty (“nose job”)
• Botox injections
• Laser hair removal

Cosmetic surgery may be covered if it’s needed after an accident, injury or illness and is considered reconstructive.

#7 Dental and vision coverage

Basic health insurance plans may not cover dentist and optometrist visits. Dental and vision coverage usually needs to be purchased either as separate plans or as additional riders to a main health insurance plan. Dental emergencies from an accident may be covered by your health insurance plan.

#8 Obesity-related treatments

Weight-loss medications and other interventions for obesity, including weight-loss (bariatric) surgery, nutritional counselling, weight-loss equipment and more, are often excluded from health insurance plans. However, if your BMI is over 40, they may cover weight-loss surgery.

Buy supplemental insurance

Despite this long list, all is not lost! You can cover most health insurance exclusions with what’s known as supplemental insurance.  These optional riders can be used to cover just what you need, and also to ensure that you’re not paying for cover that you don’t need. Dental, vision and maternity coverage can all be bought in this way.

Interested in looking at supplemental health insurance offered by top insurance providers? Reach out to Pacific Prime for advice or a free quote.

Research alternatives for the excluded services

A final tip: if a specific medical service is denied, check whether there are other treatments that address the same condition and are still covered. For example, if homeopathic services are not covered, see if you can find an alternative solution that is covered.

Pacific Prime’s advisors are also only one phone call or email away if you’d like to discuss your health insurance options. As each individual and situation is unique, advisors provide unbiased insurance consultations and offer a no-obligation quote.