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Read the fine print of your insurance to learn about potential exclusion conditions

By Dr Alfred Murage | April 10th 2022 | 2 min read

Those with private medical insurance will be familiar with exclusion clauses within their medical cover. Basically, exclusions are medical conditions that aren’t covered by your existing insurance policy.

Common exclusions within a general medical cover include dental or ophthalmic conditions. Some only become aware of such exclusions when the need arises. But if you comb through the small print of your insurance policy, you’d always be in the know about such exclusions.

The easiest way to avoid nasty exclusions within your medical cover is to ensure you only sign into a policy that suits your foreseeable needs.

A medical insurance agent can help review your prevailing health status, and advise on a medical cover that suits you. Try as much as possible to sign into a broader cover, with minimal exclusions. It might cost you more, but it’s better than getting caught out much later with an exclusion that could have been avoided. But some insurance policies have exclusions that aren’t explicit from the word go.

This causes much heartache to patients when faced with bills that weren’t anticipated. Insurance providers could do better by eliminating ambiguity from medical insurance policies they offer. Others are faced with bureaucratic approval processes as they access medical care. This often causes delays with medical interventions, eventually contributing to poor outcomes. 

Women’s health is fraught with insurance exclusions. Some have pregnancy-related exclusions, which sometimes come as a surprise to both patients and clinicians alike. Those with infertility have major insurance exclusions.

This is despite the World Health Organisation (WHO) and other women’s health organisations labelling infertility as a disease like any other, and even linking it to human rights. What isn’t evident to insurance providers is that they actually pay for some inefficient infertility-related procedures that cost them more in the long run. Re-looking at exclusions that appear discriminatory has benefits to both insurance providers and women’s health in equal measures.

What can you do if faced with medical insurance exclusions that appear at odds with your healthcare needs?

The medical insurance business is so competitive that you are likely to find a more flexible provider. Local medical insurers could borrow a leaf from international insurers who mostly individualise medical covers, and limit exclusions to suit. Obviously, all this comes at a premium as well.   

If all else fails, you can always lobby for more inclusive medical insurance. Lawmakers and other stakeholders should be your point of call.


Dr Alfred Murage is a Consultant Gynecologist and Fertility Specialist. [email protected]

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