5 Things Not Covered By Medical Insurance

Surprise, surprise! Medical Insurance doesn't cover you for everything. Prepare yourself by checking out our list of 5 Medical Insurance Exclusions.

Health Insurance, or more formally know as Medical Insurance is a form of protection that can be used to cover medical costs arising from any health complications and/or accidents that you might experience. To put it simply, being under medical insurance coverage is akin to walking around with a giant invisible umbrella. If you break your leg in an accident tomorrow, you don't have to panic and worry about medical costs, all you have to do is lie back and relax on your hospital bed while your insurance company takes care of the associated costs. Sounds like a good deal right? 

Unfortunately, insurance companies don't always cover everything. Within the mass of mile long terms and conditions associated with every medical insurance package lies a discrete list of coverage exemptions. Believe it or not, every medical insurance package comes with exemptions which can vary from just one or two simple scenarios to a detailed and complex checklist of exclusions. So don't set yourself up to be tricked, read on for our list of the five most common medical insurance exemptions. 

1) Pre-Existing Conditions

More formally, a pre-existing condition is a medical condition that has occurred before the insured person began his/her medical insurance coverage. Pre-existing conditions are not covered by all medical insurance companies. So for example, if you were diagnosed with a terminal heart condition today and decided to sign up for medical insurance tomorrow then your heart condition would be considered a pre-exisiting condition and will not be covered by the insurance company. 

Think about it, lets say that every terminally ill person in the world signed up for medical insurance the moment they found out they were sick and subsequently made claims on their medical bills 3 - 4 months later, if that was the case, then how would medical insurance companies turn a profit? Technically it would be impossible. They would get bombed by claim after claim after claim while receiving minimal or no premiums at all. In fact, if pre-exisiting conditions were covered by medical insurance companies then the industry as a whole would go bankrupt within a year. 

2) Plastic Surgery

Thinking about having your medical insurance cover your latest nose job? Well think again! Whether it be chin implants, face lifts, tummy tucks, boob jobs or butt jobs, all these modifications (while expensive) are not covered by medical insurance.

Plastic surgery is generally considered an optional medical procedure and not a life saving one. This means that having or not having plastic surgery does not mean the difference between life or death. 

For example, having a nose that makes you look like Grover does not mean that you're going to die, it just means that people will laugh at you when they see you. So while you might want to get surgery to correct that defect and subsequently enable yourself to live a more normal life, failing to change that one aspect of your appearance will not directly lead to you physical demise. 

Always remember that medical insurance companies only cover conditions where medical attention is absolutely necessary and not situations where surgery is a luxury and/or can be entirely avoided. 

3) Any Claims Within 30 Days

If you purchase a medical insurance package today, it doesn't mean that you are automatically covered immediately. While this may surprise you, medical insurance companies normally have a so called "cooling off" period right at the start of your coverage where you cannot make any claims whatsoever. The period usually lasts around 30 from the time that your coverage has begun. However, depending on the company, the time period may fluctuate.

Medical insurance companies do not implement the "30 day rule" to screw you over. The sole purpose of this rule is to protect the company from fraudulent claims by insured candidates who may have lied about pre-exisiting conditions in their application forms.

While this rule may seem like a travesty, there are extreme exceptions to the "30 day rule". For example, any incidences involving accidental injury (such as vehicle collision injury) might still be covered by some medical insurance packages. To be absolutely sure, you should always ask your medical insurance provider to clarify when your coverage actually begins and whether there are exceptions during the interim period where you are not provided with any coverage.

4) Dental Trips

While it may be important to visit the dentist once every 6 months, don't expect your trip to be covered by your medical insurance company. Similar to the case of Plastic Surgery, most medical insurance companies view dental visits and their typically associated procedures such as scaling & polishing for example, as a cosmetic expense and not a matter of life or death.

Though there is one clear exception to this rule, if the surgery pertains to a major medical condition such as an infected wisdom tooth or serious gum disease, then your medical insurance company might cover the cost. However, there are some medical insurance packages on the market that do not cover dental visits at all, no matter how severe the case! To avoid landing yourself in such a sticky situation, always ask your medical insurance officer whether the package you are interested in covers emergency dental visits and to what extend. 

5) Claims Made While Breaking the Law

Got injured while robbing the bank? Call the ambulance! but don't call the medical insurance company, because they will not (under any circumstance) provide you with coverage if you get injured whilst breaking the law. 

Medical insurance companies are designed to be there to cover you in your time of need, like when you get hurt or sick under accidental circumstances. If you role play as Jessie James and run off on a robbery rampage, then the medical insurance company (and probably society) will turn their back on you.


Agree or disagree with this post? Questions? You also have your word!

  • alexa

    Generally it's none except GTLA by companies, i think.

    • Ong

      Dental is coverage is never provided in any Medical Card coverage. However, if any cosmetic surgery or dental treatment required as a outcome of accident, it can be claimed under accident coverage.

      • Johnny Lydon

        any insurance cover allergy problems?

        • RinggitPlus

          That might depend on what you mean by allergy problems. Allergy shots you need from clinics might be covered differently from an allergic reaction that requires hospitalisation.
          Try consulting with your insurer to find out?
          Hope this helps

        • Nitha

          My mom underwent an open heart surgery (hole in the heart issue) more than 10 years ago. Is she still eligible for insurance now? She got no other medical issues now. Please advise a card if available.

          • RinggitPlus

            Hi Nitha,

            Thanks for reaching out to us! Generally speaking, most insurance providers will consider a previous illness (as is the case with your mother's heart surgery) as a pre-existing condition. This means that your mother might still be eligible for a medical insurance policy (she might have to go through a medical examination as part of the application process), but her pre-existing condition will not be covered by the policy.

            Of course, insurance providers are offering more benefits and perks these days, so it's advisable for you to check with the insurance agent or provider before buying a policy for your mother.

            Have a look at the available medical insurance available in the market on our comparison page at https://ringgitplus.com/en/health-insurance/medical-card/ and we hope you'll find the perfect insurance policy for your mother!

          • Leon

            And medical insurance in Malaysia doesn't cover STD or STI.

            • Kate

              hi there,
              i am a type 2 diabetic but still interested in getting insured. is it possible??

              • RinggitPlus

                Hi Kate,

                Diabetes is considered a pre-existing condition and won't be covered by medical insurance. You can still claim for other medical needs unrelated to it, however.

              • Jaiza

                Is it true that some of the insurance company really insured for cosmetic/plastic surgery? I have read some articles and it said that cosmetic surgery like eyelid surgery, breast implant got covered.

                • RinggitPlus

                  Hi Jaiza,

                  You may be confusing it with reconstructive plastic surgery. Some insurance policies will cover plastic surgery that's non-cosmetic.
                  Meaning if they damage their face such that they can't eat or breathe right, then that might be covered. We're definitely sure no insurance policy covers breast implants. That we know of, anyway.
                  If you're looking for a good insurance plan, check out our insurance page here: https://ringgitplus.com/en/health-insurance/medical-card/

                • M

                  Miss A was a healthy person and started her personal medical insurance early and then diagnosed with Type 2 Diabetes at age 45.
                  Miss B was also a healthy person but didn't sign up for any personal medical insurance. Then she was diagnosed with Type 2 Diabetes at age 45.

                  In terms of coverage (exclusion etc) and premium fees/charges, would there be any major differences for Miss A to renew her personal medical insurance vs Miss B to sign up for personal medical insurance for the first time?

                  Does it make a difference to Miss B's personal medical insurance premium and coverage, if Miss B was covered by her employer's group insurance previously but no longer so?

                  • RinggitPlus

                    Hi M,

                    In the case of Miss A, for her next renewal, the insurer would ask her to add some Critical Illness cover since they're typically not part of a standard medical policy. This may be an add-on to her existing one, or she may have to sign up to a different policy altogether.
                    With Miss B, most insurers won't cover her condition, with the possible exception of Allianz with their Diabetic Essential policy: https://ringgitplus.com/en/health-insurance/medical-card/Allianz-Diabetic-Essential.html
                    It won't make a difference to Miss B if she was previously covered but no longer is. She would be treated as if she never had coverage.

                    Thanks for your questions! We hope this helps!

                  • Tom

                    My mother died of cancer at 71 years old so can I buy medical card at age 41 and family health problems really important. Can I lied to insurance company that all family members are healthy. Me and my wife and three children are perfectly healthty except my mother died of cancer

                    • RinggitPlus

                      Hi Tom,

                      You really shouldn't lie to your insurers since that's considered as fraud. It's their duty to check on your health status by going through your medical history as well, so it's really not a good idea to do this.
                      However, medical insurance doesn't have to be expensive or cumbersome to pay for. You can check out our medical insurance comparison page: https://ringgitplus.com/en/health-insurance/medical-card/ to find the best medical cards that fit your budget.
                      Thanks for your question and we hope this helps!

                    • Cj


                      Is high/ low blood pressure falls under the category of “pre-existing condition” therefore on the event of heart related issues will not be covered?

                      • RinggitPlus

                        Hi, CJ.

                        This part is hard to say. Each insurer has their own definition/ inclusion of what disease is considered as "Pre-existing conditions". It is in your best interest to check with your respective insurer.

                        Thanks for the question and we hope this help.

                      • Cam

                        Hi there, if a patient has a pre-exisfing condition, but the insurance approved and made some query to the hospital and approved it again, can they decline it last minute specially after the procedure has been made?

                        • RinggitPlus

                          Hi, Cam

                          It depends on the context. If your insurer knows that you have a pre-existing condition and approved your claims, then they cannot go back on their approval. However, if they do not know about your pre-existing condition when they approved and only found out about it after they enquire from the hospital, then they will not entertain your claims. We also advise you to check your policy for such clause.

                          Thanks for question and we hope this helps.

                        • jenloi


                          • RinggitPlus

                            Hi there,

                            Some medical insurance will provide for extra dental benefits, and yes, generally they are only covered if caused by accident or injury. However, there are dental insurance plans that specifically covers all oral health treatment including filings and extraction. Hope that helps!