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Conditions or circumstances spelled out in an insurance policy which limit or exclude coverage benefits. It is important to read all exclusion, limitation, and reduction clauses in your health insurance policy or certificate of coverage to determine which expenses are not covered.
- Browse Related Terms: Appeal, Attest/Attestation, Carriers, Certificate of Coverage, Certificate of Creditable Coverage, Exclusions and/or Limitations, Independent Medical Review (IMR), Insurance Company, Medical Underwriting, policy, Reinsurance, Solvency, Summary of Benefits and Coverage, Summary of Benefits and Coverage (SBC)