What conditions are not covered by medical insurance? Blog Image

What conditions are not covered by medical insurance?

5 October 2022

What is not covered by Health insurance?

Many people who fall under various medical insurance lists are wondering about what is not covered by Health insurance? Do they vary depending on the type of health insurance, and the individual's health status, or do they depend entirely on what the health insurance company specifies? Here are the details under the following text.

In the following article, we provide you with a detailed explanation of each of the cases that are not covered by medical insurance, if you have any inquiries about more specific cases or about the future of medical insurance, you can contact us through: (+ 02-274 98 131,+ 02-12 00 1111 33) (info@brokerage-insurance.com)

What is not covered by medical insurance?

Each of the following actions falls under the list of cases that are not covered by medical insurance:

  1. Cosmetic surgery/procedures:

  • Treatments that are requested for cosmetic purposes - acne treatments, laser skin procedures, etc. - or cosmetic procedures such as rhinoplasty, breast surgery, etc., which are considered medically non-mandatory operations.

  • Hair transplantation or hereditary baldness treatments.

  1. Maternity:

  • Coverage of pregnancy and childbirth for women who began to become pregnant on a date prior to contracting health insurance.

  1. Suicide attempts:

  • Intentionally caused injuries such as any kind of suicide, quarrels and violent acts, civil wars, skirmishes and other violent acts.

  1. Psychotherapy:

  • Treatments received in health care institutions and nursing homes.

  • Neuro and mental disorders, except if they are severe and threaten an individual's life, and the insurance policy provides for their coverage.

  1. Cosmetic dental procedures:

  • All procedures related to dental implants, as well as fixed or mobile dental implants, bridges or installation of orthodontic devices, except in the event of a violent accident.

  1. Special hearing procedures

  • Medical examinations related to vision correction and hearing, or the installation of visual or hearing aids, except in the case of a special request from the insured company.

  1. Other exclusions:

  • Operational and comprehensive examinations, which are only for the purpose of checking on general health, as well as non-mandatory preventive measures in medical treatments, except those specified by the Ministry of health such as vaccinations, births and child care.

  • Work injuries resulting from exposure to Ionic substances, radioactive substances or any of the nuclear waste resulting from the burning of nuclear fuel.

  • Cases of weakness and congenital malformations, unless they pose a danger to the patient's life, and the insured's company has issued approval to bear the costs of treatment.

  1. Special diseases:

  • Sexually transmitted diseases or venereal diseases.

  • Treatment and diseases that fall under the list of acquired immune diseases such as AIDS and other similar diseases.

  • Hereditary and genetic diseases, which are related to hormonal disorders of any kind.

  • Treatments related to hormone disorders - any hormone therapy aimed at regulating reproduction or contraception, as well as treatments for infertility, impotence, secondary infertility, and external pregnancy procedures such as ICSI or any of the methods of artificial fertilization.

  • Conditions that occur as a result of menopause period in women (Postmenopausal syndrome).

  • Diseases that appear as a result of taking certain medications, stimulants, or treatments for depression, sedatives, and narcotic drugs.

  1. Special cases:

  • Acne treatment or any procedure related to obesity or overweight.

  • Organ transplants, prosthetics, or spinal cord transplants.

  • One of the most famous cases that are not covered by medical insurance: is the costs of treatment with alternative medicine and associated medicines.

Is Psychiatry on health insurance?

Psychiatry is one of the cases that aren’t covered by medical insurance, but some health insurance companies have agreed that there are 3 types of mental illness coverage, which are as follows:

  • There are some companies that do not admit the treatment of mental illnesses except in emergency cases and cases that threaten the patient's life to consider them acute cases, but they are considered to be cases that are not covered by medical insurance except in the cases of VIP medical insurance policies.

  • Others consider the policy followed by most insurance companies, which is to cover emergency psychiatric cases and a specific number of clinic visits.

  • The third part is health insurance companies that cover a certain number of visits to psychiatrists as well as part of the treatment but do not include psychotherapy sessions.

Is dental cleaning included in the insurance?

If the procedure is for a cosmetic purpose, as we mentioned earlier, cosmetic procedures are not covered and are considered cases that are not covered by medical insurance, in addition to other procedures such as dental implants, artificial teeth, fixed or movable bridges, or braces, all of these cases are considered for cosmetology and not treatment, so most health insurance companies do not cover them except in rare cases depending on the insurance policy under which the insured is listed.

To clarify: if the policy that you have chosen or the company you are affiliated with has chosen falls under the list of dental treatments and cosmetic conditions (such as VIP insurance policies), this case can be excluded and included under medical insurance.

Finally, after we mentioned most of the cases that are not covered by medical insurance, as well as pointed out some special procedures such as dental and psychotherapy, we hope that we have clarified all the details, and if you have any further queries about the policy of brokerage health insurance company for people please contact us on: