Health Insurance: What is a Health Insurance Exclusion?

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A health insurance exclusion is something that your health insurance plan will not pay for even if you need it in order to get, or stay healthy. In other words, a health insurance exclusion is anything that is excluded from coverage by your health plan. The particular health care service that the company will not cover, is excluded from your health insurance coverage benefits.

Each individual health plan is different, and each will have its own list of health separate health insurance exclusions.

Some health insurance plans cover things that other plans do not cover.

However, there are similarities between many plans. Thus, according to a 2014 study from HealthPocket, the most common exclusions in individual and family health insurance plans are:

Long-Term Care: Long term care is a type of medical service or support given to an individual to help meet health or personal care needs over an extended period of time. Some companies are not eager to offer consistent care over such an extended period of time.

Cosmetic Surgery: Cosmetic surgery is a procedure, or series of procedures intended to alter the physical appearance of an individual.

Adult Dental Services

Weight Loss Programs: Many adult individuals deal with weight loss issues. Weight loss coverage varies from company to company.

Acupuncture: Acupuncture is a part of traditional Chinese medicine. It originated in China more than 5,000 years ago.

Acupuncture is based on the belief that humans have a vital energy, which is referred to as "qi” that circulates through twelve separate invisible energy lines, or meridians, on the body. Acupuncturists insert needles into points along these meridian lines in order to influence and restore balance to the flow of qi.

There are over 1,000 separate acupuncture points on the body. Many health insurance companies do not view acupuncture as legitimate, or necessary, and thus do not cover it on health insurance plans.

Covered Benefits

The opposite of health insurance exclusions are covered benefits. Covered benefits are additional aspects that your health plan will pay for. For example. If a particular health care provider covers cosmetic surgery that may be considered a covered benefit. Again, covered benefits vary from company to company and even from plan to plan.

10 Essential Health Benefits

Health insurance sold in the United States must include the 10 essential health benefits mandated by the Affordable Care Act as covered benefits. Comprehensive health plans sold in the United States aren’t allowed to exclude any of the essential health benefits from coverage.

More Information

Find more information regarding insurance exclusions and covered benefits below:

5 Surprising Things Not Covered By Health Insurance

I Have Health Insurance. Why Do I Still Have to Pay for Health Care?

Why Your Health Insurance Won’t Pay for Your Health Care

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