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Medical Insurance Exclusions to Watch For

Unfortunately health insurance can't cover every condition, so we've compiled a list of specific exclusions to look for before purchasing a new plan.

In a nutshell, an exclusion is a condition or instance that is not covered by your insurance plan. Just as each plan has a list of items that the insurance company will cover, they also have a list of items they will not. While there could be several reasons why a specific condition or doctor visit is not covered, it’s important to review and actually understand the exclusions of an insurance plan before purchase. Our licensed insurance agents are here to help you comprehend both plan benefits and exclusions, so feel free to contact us with any questions you may have.

Common Insurance Exclusions

Pre-Existing Conditions

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Tip: If your pre-existing condition is considered excluded, you will not receive any benefits for related doctor visits, prescriptions, hospitalizations, etc.

A pre-existing condition is any illness or injury that you had before the plans effective date. This includes anything that has exhibited symptoms or you have been treated for within a specific time period before the plan begins, and even conditions you may not be aware of. Annually renewable plans, like the Global Medical are more likely to include coverage for those conditions, but a waiting period may still apply. Be wary that even after a waiting period some conditions may still be excluded from coverage, so be sure to check with the policy wording.

Dental and Vision

Of course it would be convenient for both dental and vision to automatically be covered by insurance plans, but this is not always the case. In addition to traditional medical insurance, companies oftentimes sell plans specifically for dental and vision, or these benefits may be offered as an additional rider to an existing plan.

Maternity

It’s important to verify the exact wording for both the coverages and exclusions for maternity, as they vary greatly between plans. Perhaps the delivery is covered but the pre-natal and post-natal care is excluded. Something else to keep in mind is that some short-term plans, like our Atlas Travel provide coverage for complications due to pregnancy, but were not created to cover the entire pregnancy. Typically plans will exclude maternity coverage completely if the individual is already pregnant before the effective date.

Alternative Medicine

While you can assume that more traditional types of medicines will be covered, alternative and complementary medicine is often an exclusion. Quickly growing in popularity, these medicines are treatments and procedures used together with conventional medicine including:

  • Acupuncture
  • Acupressure
  • Yoga
  • Massage
  • Biofeedback

Sports

One of the more common exclusions to watch out for is organized sports coverage, especially for international students. Typically recreational activities like a game of basketball with friends is covered, but as soon as the sport becomes organized, for example through a school or club, exclusions may apply. Check your benefits to ensure that sports are covered, the sport you will be participating in is not specifically excluded, and that you understand any exclusions that are listed related to sports.

Mental Health

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Tip: Treatments for substance and alcohol abuse are common exclusions, as is suicide.

While mental health can be considered just as important as physical health, it’s not always covered by traditional insurance policies. Often required for international students by their college or university, it’s important to find a plan that covers an array of mental health conditions as a proactive measure

Outpatient Prescriptions

When you visit the doctor you may be prescribed medication to help the healing process of your injury or illness. Depending on the drug you need, this fee can take a good chunk out of your wallet so it’s important to verify these costs will be covered by your plan. It’s also important to know how your prescriptions will be paid for since international plans often require you to pay for prescriptions out of pocket and then be reimbursed through the claim process.

3 Reasons To Read Your Master Policy

Commonly referred to as the description of coverage, be sure to look at the fine print of your insurance plan. All of the details not included in brochures and online will be listed in one lengthy document – the same document that the insurance company will use to decide if your claim will be paid, so it’s best to take some time understanding it. While we can’t stress enough the importance of this document, listed below are a few of the many reasons to do some research.

Reason 1: The full explanation of any capped benefits, meaning the dollar amount an insurance plan will pay for a specific treatment, if applicable, will be listed in this document.

Reason 2: This is also where you will find the cancellation policy. While most plans will issue a full refund if you cancel before the effective date, some will only issue a refund within the first few months of coverage – even if you have already paid for the entire year.

Reason 3: Sometimes plans offer the option to add additional riders, allowing you to include specific benefits like adventure sports and maternity to your plan for an additional cost, but it’s still important to know exactly what will be covered under those riders. If you would like to learn more about insurance terminology (like riders), read our article “Important Insurance Terms”.

Let The Search Begin!

Don’t find a plan that merely satisfies your school or visa requirements and purchase it on the spot. Remember that no insurance plan can cover everything, so it’s important to prioritize what you would like to be included in your plan. Oftentimes, it’s helpful to contact the insurance company that you wish to buy the plan from, and ensure that you fully understand what will and will not be covered by the plan so you can budget for out of pocket expenses.

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