What Expenditures Are Excluded Under Major Medical Expense Plans?
There are a variety of exclusions and limitations with respect to health insurance.
Common exclusions include:
- Pre-existing conditions
- Substance abuse
- Attempted suicide
- Mental illness
- Reimbursement through a Workers’ Compensation insurance program
- Cosmetic or elective surgery and procedures
- Optical and dental coverage
- Prescription medicine
- Procedures determined to be preventive care
You’ll have to review your policy carefully to catch all the exclusions.
Here are a few more common health plan exclusions to look for:
- Convenience and Comfort products such as cough syrup, or humidifiers, band-aids,
- Private Nursing Services or In Home Nursing Care
- Dental Health Services, Hearing or Vision Aids
- Elective Abortion Services
- Vasectomy or Sterilization Reversals
- Treatment for Behavioral or Learning Problems
- Experimental Medical Treatment or Non-Prescription Drugs
- Sex Changes and/or Reconstructive/Cosmetic Surgery (Breast reconstruction
surgery is generally considered an exception while circumcision is usually
considered cosmetic therefore not covered)
To make sure you don't get a bill that you did not expect, it’s important
to know exactly what your health plan excludes.