Policy exclusions – What your health insurance might not cover
With the passage of time people have recognized the importance of health insurance, and the way it serves during emergencies. The insurance company takes over the risks associated with you in exchange of a fixed premium, and you can stay assured that your medical expenses will be covered.
However, you can’t expect your health care plan to pay for all your medical bills. The health insurance plans come along with exclusions, which are mentioned in respective policy documents. It is advisable to know about your policy exclusion in advance, so that you don’t end up paying your bill out of your pocket even after having health insurance coverage. Read along to know about the common policy exclusions for health insurance:
- Pre-existing conditions – The medical conditions which were present with the insurer before the policy is purchased are known as pre-existing conditions. Health insurance plans usually come along with a waiting period for pre-existing conditions, i.e. they provide coverage for those medical conditions only after a specified time period. The waiting period is also applicable if the individual had a lapse in coverage.
- Cosmetic surgeries – Most health plans deny coverage for cosmetic surgeries, especially if they are to be done for beautification of the insured rather than for any medical requirement. Such surgeries might be covered by the insurers only if it’s recommended by the doctors, or in case the surgical treatment is done for reconstructive purposes after an injury or to correct a birth defect. Thus, if you want to have a face lift or a liposuction, be prepared to pay out of your own pocket.
- Unconventional treatments – Alternative treatments like acupuncture, yoga, massage, aromatherapy or naturopathy etc. that are used in place of the regular medical treatments or along with it, are usually not covered by the health insurers. These forms of medical treatments are considered as non-traditional and experimental, and thus have to be paid on your own.
- Mental health treatments – Some insurers deny coverage for mental illnesses and corresponding treatments. Special coverage as per doctor recommendations might have to be opted for, if an individual has to undergo services for drug rehabilitation or substance abuse.
- Treatments for behavioral or learning disorders – Medical insurance plans might refuse to pay for the treatments if the insured develops behavioral or learning problems like dyslexia or ADHD. These forms of illnesses are generally not covered since the treatments can continue for extensive time periods.
- Home and private care – Expenses for private nursing or home care facilities are usually excluded from the health insurance plans.
- Drug benefit exclusions – Special medicinal protection or non-conventional drugs will not be included under the medical insurance plans. This means that the food supplements for clear skin or strong nails, experimental drugs and tonics or hair growth stimulants etc, are not covered under your health insurance policies.
- Dental, hearing or vision care – Health insurance plans usually don’t cover the expenses for the regular dental, hearing and vision care, unless such issues crop up as a result of accidental injuries.
Apart from the above mentioned ones, the health insurers also have specific exclusions which vary from one insurer to another. Abortions, pregnancy or diagnostic treatments might not be covered by the conventional health insurance policies. Thus, it’s advisable to check your policy documents thoroughly to know which medical conditions won’t be covered by your insurer.
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