If you have been diagnosed or treated for a previous condition, illness, or injury, before you were insured, the health insurance carrier may not want to cover continuing treatment for that medical condition. The carrier does not want people to wait to purchase insurance coverage until they know they will need treatment. When a condition is already known to the consumer, the carrier may offer health insurance that covers other conditions that arise, but excludes treatment for anything that was pre-existing before the insurance was purchased. Naming specific illnesses, injuries or conditions that are “exclusions” on the policy means that the carrier will not pay for any treatment associated with them. Some individual health policies may allow coverage for the pre-existing condition after a certain time period (usually 12 months) has passed with continuous health insurance coverage.
An exclusion in your policy may also mean refer to anything the health insurance carrier will not cover, ranging from a type of drug to alternative treatments to a type of surgery. These exclusions can vary from policy to policy. A hospital stay may list a number of exclusions, sometimes anything “extra” that is not a medical necessity – from watching a rental television to using a hospital phone to deluxe meals – may not be covered. Cosmetic or elective surgery is often excluded, unless it is done in response to a medical condition. Dental treatment and vision needs are usually excluded unless treatment is required due to an accident or illness. If dental and or vision treatments are covered, it should be spelled out in your policy.
An exclusionary rider is a part of your policy that states when there are certain conditions or types of illnesses that will NOT be covered by your policy. The exclusionary rider eliminates coverage for any medical treatment associated with the medical condition or previously diagnosed illness specified on the rider.
- Browse Related Terms: Creditable Coverage, Creditable Coverage or Prior Qualifying Coverage, Disclosure, Discount Health Plan, Elimination period, Exclusion, High Risk Pool Plan (State), High-risk pool, Maryland Health Insurance Program (MHIP), Minnesota Comprehensive Health Association (MCHA), Portability, Pre-existing Condition, Pre-Existing Condition (Job-based Coverage), Pre-existing condition exclusion, Pre-Existing Condition Exclusion Period (Individual Policy), Pre-Existing Condition Exclusion Period (Job-based Coverage), Pre-existing Condition Insurance Plan (PCIP), Rider (exclusionary rider)
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