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What's not covered?
(This is a general overview
of items that are usually not covered.
Please READ health insurance policies
carefully before buying.)
HMO health insurance is
generally more comprehensive than Fee-for-Service
health plans. However, NO health insurance
plan covers all medical expenses. Common
exclusions in coverage include:
-
Cosmetic
Surgery - Very few health insurance
plans cover cosmetic surgery except
in cases of corrective damage caused
by accidental injuries.
-
Gynecological
exams - Some Fee-for-Service
health plans do not provide coverage
for routine medical checkups or
gynecological exams (pap smears,
mammograms, etc.) Read over policy
choices carefully.
-
Pregnancy
or childbirth - Some health
plans don't cover pregnancy or childbirth
except maybe complications of pregnancy.
-
Experimental
or non-traditional procedures -
Most health plans do not cover
medical procedures that are considered
experimental or non-traditional.
-
Mental health
coverage - Very few health
plans provide mental health coverage.
Some may provide benefits for acute
conditions only.
-
Not
medically necessary - Certain
medical procedures that your insurer
determines are not medially necessary
won't likely be covered.
Other
exclusions
Insurers do not
provide duplicate benefits. Coverage
for medical expenses can not exceed
100% of the allowable cost even if you
and your spouse are both covered under
each others separate health plan. This
provision is known as "coordination
of benefits". This helps keep overall
insurance costs down by not allowing
anyone to pocket the extra benefits.
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