Understanding Limitations And Exclusions Of Your Health Plan
Monday, May 3rd, 2010 by adminMany people hold the misconception that it is necessary to purchase health insurance coverage only when they are injured or become ill. This is far from the truth. Just imagine if no one invested in a health plan until they discovered they had cancer, or until they were in a car accident and sustained neck and back injuries. If this was the case, premiums for all health plan members would be extremely high.
Health insurance coverage is designed to assist with medical costs should one become ill or injured. Medical bills can take a huge chunk out of our finances and no one can afford to pay this amount for a long period of time. So, a health insurance plan should be purchased when a person is relatively young and healthy. Every insurance company sets their own rules and standards and it is important to read these through carefully so that you are aware of what services are covered and which are excluded.
Some of the most common exclusions include, but are not limited to, the following:
Glasses or contact lenses are normally covered through separate plans and are subject to limitations. You may only be allowed to spend up to a certain amount during a set calendar year. Physical therapy may also follow these same rules. Come companies allow you a certain number of visits and some may cover an unlimited number. If you are required to enter a substance abuse clinic, this form of rehabilitation is often not covered by your health insurance coverage; you must pay for these services out of your own pocket. Fertility treatments, such as In Vitro Fertilization or ovulation induction may also be excluded from your health plan. Cosmetic surgery, unless medically warranted, is also another example of a service that plan members must pay for themselves.
One of the most important limitations of health insurance coverage talks about pre-existing conditions. Basically, this is a medical condition that was present before you purchased your health insurance. A pre-existing condition could be high blood pressure, cancer, diabetes, asthma, or a back injury sustained a year ago in a work related fall. Some insurance companies will flat out refuse to provide coverage for any pre-existing condition. Others may place limitations or waiting periods. This simply means that you will not receive any coverage for that particular condition for a set period of time. Once that period of time has expired, you will then be able to make claims regarding that pre-existing condition.
In short, you should always review all coverage and exclusions before purchasing a health insurance plan so that you are not surprised should you need to file a claim.

