What Is and Is Not Covered by Your Health Insurance Policy?:

The term exclusion frequently appears in relation to health insurance policies. Simply defined, this means that specific services will not be covered by your health insurance plan. It is important to understand what these exclusions are before you purchase your plan.

Here are the top ten most common health care plan exclusions:

1. Comfort or routine items. If your doctor prescribes a humidifier, and your plans lists this as an exclusion, you will not be able to have your insurance policy cover the cost of the purchase. This may also include simple items such as over-the-counter medicine and other common needs.

2. Extras during a hospital stay. If you request extra pillows, bandaids, or long distance calls during a hospital stay, your insurance will most likely not provide coverage for these items.

3. Cosmetic or reconstructive surgery. This type of procedure is generally not covered by health insurance, although there may be exceptions if the procedure is medically necessary, such as breast reconstruction. Make sure that you ask your health insurance company to clearly define what they consider medically necessary.

4. Home care or private nursing services. While an insurance policy may cover your stay at a nursing home, they generally do not provide coverage for in-home care. If you prefer to receive care at home, you may need to find a policy that provides this coverage, or add-on a long term care option or policy to your coverage.

5. Dental care. Dental insurance will typically need to be purchased in addition to your health care insurance. While some plans do provide coverage for dental work, the majority of them do not.

6. Vision care. It is difficult to find a regular health insurance policy that provides coverage for vision care, such as glasses, contacts and doctor visits. However, most plans do offer benefit riders if you are in need of this coverage.

7. Sterilization reversals. While an insurance policy may cover a vasectomy or tube-tying operation, they will commonly not provide coverage for the reversal of these procedures.

8. Behavioral and learning problems. If you need the care of a specialist or medication for a learning disability, this type of coverage is typically not included in the average health plan.

9. Elective abortions. Non-medically necessary abortions are usually not covered by the majority of health insurance plans.

10. Experimental treatments and/or non-prescription drugs. Any treatments that have not been declared valid by the FDA or by your insurance company will not be covered if your plan has this type of exclusion. Non-prescription drugs, even if they are medically necessary are also not covered. Even if your doctor prescribes an aspirin a day for your heart health, your insurance policy will not cover the purchase of the aspirin.

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