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Inside this Article
Health Insurance - Typical Limitations
and Exclusions
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Polices will vary quite a bit on their limitations and
exclusions so it is always very important to read the actual policy (not
the marketing information) carefully before making a selection.
Here are
some limitations and exclusions common for many health insurance
policies.
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Health Insurance - Pre-existing
conditions
Most health plans will have waiting periods of six months to a year
for pre-existing conditions if you have had a lapse in coverage. For
example, if you're diabetic and leave your job but don't begin a new job
right away where you would have coverage, you would have to pick up an
individual insurance policy or find coverage somewhere else
(through a spouse's employment maybe) in order to avoid a waiting period
with your next policy.
Health
Insurance - Cosmetic surgery
Health insurance rarely covers
cosmetic surgeries. Usually they must be for reconstructive purposes
after an injury or due to a birth defect. They may also be covered if a
doctor states that there is a medical need for it. You'll have to pay
for that face lift or liposuction out of your own pocket.
Health Insurance - Non-traditional
treatments
More health plans are now covering what used to considered
non-traditional treatments such as acupuncture and alternative birthing
centers. Always check your policy if you use these treatments.
Health Insurance - Routine check-ups
While managed care policies always covered routine physicals and
other checkups, fee for service plans usually do not.
Health Insurance - Mental health
treatment
Some plans cover mental health treatment as well as drug
rehabilitation.
Although, some only cover substance abuse if it
co-occurs with mental illness.
To get access to these types of services
you may be required to get a referral from your regular doctor first.
Mental health and substance abuse services may also be offered through
an employee assistance program (EAP) if your employer has one.
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