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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, etc.
  • 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.

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