What Is An Exclusion?
An exclusion is defined as something that your medical insurance will not cover. Therefore, a person cannot receive money or reimbursement from their insurance provider to pay for something that is excluded. An exclusion may range from specific doctors to prescriptions. However, some of the most common types of exclusions include pre-existing conditions and pregnancy. Many small businesses and their employees may be interested in an insurance’s inclusions (unsurprisingly, the opposite of exclusions) but oversee analyzing exclusions.
What Are Some Common Healthcare Insurance Exclusions?
- Cosmetic Procedures
A cosmetic procedure is usually performed to alter or enhance a person’s appearance, so insurance companies often perceive it as voluntary. However, a cosmetic procedure may be a medical necessity in the case of an accident or injury. In that case, an insurance policy may be willing to cover expenses.
- Pre-Existing Conditions
Pre-existing conditions are defined as medical ailments that began before a person’s health insurance went into effect. These conditions include but are not limited to cancer, diabetes, asthma, epilepsy, etc. Often, exclusions for pre-existing conditions only last for some time. Under a job-based health insurance plan, the period for exclusion cannot exceed 12 months for a regular enrollee or 18 months for a late-enrollee.
- Pregnancy and Fertility Treatments
Many insurance policies consider pregnancy a pre-existing condition, excluding pregnancy and treatments leading up to pregnancy. Your policy may offer coverage for pregnancy care after a waiting period, which is unique to each plan. It is essential to note whether plans include or exclude things such as prenatal and postnatal care. Additionally, some plans may refuse coverage if a person was pregnant before acquiring the insurance.
- Behavioral and Personality Disorders, Mental Health
Mental health conditions are often excluded from health insurance coverage. Additionally, behavioral and personality disorders may not be covered. Some examples of common exclusions include mental health counseling, attention deficit hyperactivity disorder (ADHD) medications, treatment and medication for anxiety disorders, and more.
Small businesses should read a policy’s exclusions and inclusions to ensure they make the best choice for their employees and their budget. Luckily, MonsterQuoter makes it easy to compare hundreds of plans that best fit your criteria and budget. While shopping for your business’ perfect health insurance, you can rest assured your employees are taken care of while enjoying affordable premiums. Use our tools or contact one of our unbiased strategists to get started today!
