The biggest pain point, atleast from a Customer’s perspective, in the health insurance value chain is the claim processing vertical. More often than not the decision as to whether the Customer would continue patronizing an Insurer boils down to the qualitative and quantitative aspect of claim settlement. While the qualitative aspects are subjective and Insurer dependent, IRDAI brings in some objectivity to the quantitative aspect in terms of what claims would not be settled by the insurers. These are generally referred to as standard exclusions and are the same across the board for all Insurers.
Exclusions can broadly be classified into
A complete list of all of these exclusions can be accessed at this Link