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Common Health Insurance Policy Exclusions

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It is important that you have a knowledgeable and reliable insurance agent because jurisdictions have laws and policies differ that on specific items. Mental illness historically has been excluded from most policies.  Recently, more policies include mental illness coverage but with limitations.  The benefits are usually much lower than physical illnesses and a stated percentage of the benefit paid for other types of medical care is included.

Common exclusions and limitations: 
 
Both disability income and medical expense policies limit or exclude coverage for certain types of injuries or illness.  There is a difference between limitations and exclusions.  The mental illness policy limitations we discussed above is an example of a limitation, whereas an exclusion is completely omitted from any coverage.

Commonly excluded or limited are:

Pre-existing conditions as defined by your policy and dictated by state law

Hernia repair, however the growing trend is to cover the condition

Self-inflicted injuries

Suicide

War and/or acts of war that result in injury or death

Military duty

Non-commercial air travel

Injury while committing a felony

Injury, illness or death incurred while under the influence of alcohol or narcotics

Cosmetic surgery unless for surgery required as a result of an accidental injury or a congenital defect

Dental expense, unless resulting from accidental injury

Vision correction such as eye exams, laser surgery, eyeglasses and contact lenses

Care provided by governmental facility which is normally covered by the Veterans Administration or by workers compensation

Sexually transmitted diseases

Experimental procedures

Organ transplants

Infertility treatment and services

Alcohol and drug abuse treatment


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