The Insurance Regulatory and Development Authority of India (IRDAI) provides guidelines for health insurance policies, including standard exclusions that are typically not covered by health insurance plans in India. These exclusions help insurers manage risk and maintain affordability in premiums.

Here’s a list of standard exclusions typically found in IRDAI-regulated health insurance policies:

Standard Health Insurance Exclusions (IRDAI)

1. Pre-Existing Diseases
   • Not covered during the waiting period (usually 2 to 4 years), unless otherwise specified.
2. Waiting Period
   • Certain diseases (like hernia, cataracts, joint replacement) are excluded for a fixed period (often 1–2 years) from policy inception.
3. Cosmetic or Plastic Surgery
   • Unless required due to an accident, burn, or cancer.
4. Dental Treatments
   • Unless necessitated by accidental injuries.
5. Maternity and Related Expenses
   • Often excluded in base policies; may be covered under riders or special plans.
6. Infertility and Reproductive Treatments
   • Includes IVF, surrogacy, etc.
7. Mental Health Conditions
   • Now mandated to be included by IRDAI post-2018, but some specific treatments or conditions may still be excluded or capped.
8. Self-Inflicted Injuries
   • Including attempted suicide.
9. Injuries from War, Riots, or Nuclear Contamination
10. Substance Abuse
    • Injuries or illness due to alcohol or drug use.
11. Unproven or Experimental Treatments
    • Not recognized by medical councils.
12. Sexually Transmitted Diseases (STDs) & HIV/AIDS
    • May be excluded or capped.
13. Alternative Therapies
    • Like Naturopathy (Ayurveda, Homeopathy, etc., are covered under certain plans but not always).
14. OPD Treatments
    • Unless the policy explicitly includes it.
15. External Congenital Anomalies
    • Generally not covered.

Note: Some exclusions may vary by insurer or product. Always read the policy wording and brochure carefully.

Standard Health Insurance Exclusions – As per IRDAI Guidelines

Issued under IRDAI’s Standardization Guidelines for Health Insurance Products

Common Exclusions Not Covered by Standard Health Insurance Plans:

1. Pre-Existing Diseases (PED):
   • Not covered during the waiting period (typically 2–4 years).
2. Waiting Period Conditions:
   • Specific illnesses (e.g., hernia, cataracts, joint replacements) have defined waiting periods.
3. Cosmetic & Plastic Surgery:
   • Excluded unless required due to accident, burn, or cancer treatment.
4. Dental Treatment:
   • Excluded unless resulting from an accident.
5. Maternity & Newborn Expenses:
   • Generally excluded in base plans; covered under maternity riders or special policies.
6. Infertility, IVF, and Reproductive Treatments:
   • Not covered under standard policies.
7. Mental Illness & Behavioral Disorders:
   • Now included as per IRDAI (2018) direction, though subject to specific policy terms.
8. Self-Inflicted Injuries or Suicide Attempts:
   • Not covered.
9. Injuries Due to War, Terrorism, Nuclear Events, or Riots
10. Substance Abuse:
    • Any illness or injury arising from alcohol or drug use is excluded.
11. Experimental or Unproven Treatments:
    • Not recognized by the Indian Medical Council or equivalent authority.
12. HIV/AIDS & STDs:
    • Often excluded or included with limits.
13. Alternative Medicine (Naturopathy):
    • Excluded unless AYUSH (Ayurveda, Yoga, Unani, Siddha, Homeopathy) is specifically covered.
14. Outpatient (OPD) Treatment:
    • Not covered unless explicitly included in the policy.
15. External Congenital Anomalies:
    • Not covered under standard terms.

Disclaimer: Always refer to the specific policy document and product brochure for exact exclusions and conditions. Insurers may offer riders or customized policies covering some of the above exclusions.