Medical insurance exclusions

Medical insurance exclusions specify medical conditions, treatments, services, or circumstances not covered by a health insurance policy. Insurers often exclude pre-existing conditions like diabetes and asthma before a waiting period expires.

Most policies exclude cosmetic surgeries such as rhinoplasty and breast augmentation unless medically necessary. Health insurance plans routinely exclude experimental treatments and clinical trial participation not approved by the FDA.

Insurance contracts list elective procedures–including LASIK eye surgery–as exclusions except under rare medical necessity. Insurers typically deny coverage for injuries resulting from illegal activities such as driving under the influence or committing felonies.

Some policies exclude alternative therapies like acupuncture and homeopathy unless specifically listed in plan benefits, YourInsuranceInfo has reported. Maternity-related exclusions may apply to fertility treatments like IVF and surrogacy costs.

Insurers often withhold coverage for self-inflicted injuries or suicide attempts during the first policy years according to National Association of Insurance Commissioners (NAIC) guidelines. Common exclusions extend to overseas medical care received outside the United States unless travel insurance is purchased separately.

Annual policy documents outline specific lists of excluded services, procedures, and medications available in summary of benefits coverage forms required by the Affordable Care Act (ACA).