Knowing Your Family and Individual Health Insurance Plan Exclusions

From Bobbie Sage

What is Not Covered on Your Family or Individual Health Insurance Plan?

What is covered on your family or individual health insurance plan? What isn't? This can be a very distressing question for many. Health insurance companies are not immune from the blows to the economy therefore they have been reviewing their budgets and in doing so the "Exclusions" list in your health insurance plan has probably become even longer.

It is just as important to understand what is not covered as knowing what is covered on your family or individual health insurance plan. To find out what is not covered take a look at your health insurance paperwork. If you cannot find it call your provider and they will send you an additional copy. Although the exclusions can be spread throughout your paperwork, generally you can find a list of exclusions in it's own area usually listed as "Exclusions." As you are reviewing your health insurance exclusions section, take a look at the size of the list.

If your health plan has a very large exclusions list they have tried to find everything and incorporate it there. But, if you find the exclusions list is short, be careful. A short exclusions list usually means other exclusions are listed throughout your paperwork. After you have read through your whole family or individual health insurance plan's paperwork and highlighted every exclusion you can find take a look at the list of common exclusions below to make sure you haven't missed anything.

General Family and Individual Health Insurance Plan Exclusions:

1. Routine, Convenience, and Comfort Items: humidifiers, cough syrup,

2. Band-Aids, telephones, TV's, extra pillow's...

3. Reconstructive/Cosmetic and/or Sex Change Surgery (Breast reconstruction is usually an exception and circumcision is commonly being considered cosmetic therefore may no longer be covered)

4. Home Care or Private Nursing

5. Dental Care, Hearing and/or Vision Aids

6. Elective Abortions

7. Reversals of Vasectomies or Sterilization (Tubes Tied)

8. Learning and/or Behavioral Problems

9. Experimental Treatments or Drugs and Non-Prescription Drugs

To make sure you don't get a bill that you did not expect it is important to know what is excluded. We have all heard the horror stories behind the $10 hospital pain pill (an over-the-counter aspirin) so how much do you think an extra pillow in the hospital might cost you?

Some states mandate (make insurance companies pay) certain services that may be in the above exclusions. Contact your health insurance plan or check with your state insurance commissioner to see what is mandated in your state.