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Basic Limitations of Health Insurance

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 Basic Limitations of Health Insurance
Basic Limitations of Health Insurance

Basic Limitations of Health Insurance

One can assume that limitations are part and parcel of almost every health insurance plan and none comes without it. Health insurance providers are not genies; hence offering cover for everything isn't possible. Hence, health insurance providers usually list medical needs they won't be covering or for which they provide minimal cover. Due to this it's always best to know limitations of your plan. Some general limitations of health insurance we've tried to describe that you should be aware of.

Renewability Provision

While purchasing a health insurance plan, always look for renewability provision. Because, if there's no renewability provision in your plan, then your provider can cancel your plan in the event of you falling sick.

Lifetime Payout Provision

This is the maximum the health insurance provider will pay for your health care in your entire lifetime; it could be 1 million dollars or more. As a consumer, you're protected by a similar provision, an out-of-pocket maximum and that's the max you'll have to pay toward your health care annually. The lifetime payout provision and out-of-pocket maximum amounts will affect your premiums, so you'll need to balance the risk with the cost of the health insurance policy.

Pre-Existing Conditions & Waiting Periods

The length of waiting period to enroll into a plan varies state-to-state and your insurance provider can make you wait until after this period is over, in case you have pre-existing. This period can differ greatly, so be sure to check your policy information. A good policy should cover pre-existing conditions within a year. Some policies don't cover pre-existing conditions at all.


Prerequisites are sort of requirements that you must fulfill in order to qualify to obtain medical attention. There are some restrictions, always, but make sure your health isn't compromised because of too many steps required before you can seek medical care.

Exclusions, Limitations, and Definitions

You must read this section very carefully as it explains what is paid for, for how long and the time when it won't be paid for. If you find tough to understand all legalese, then discuss it with your licensed agent to better understand it. Treatments such as physical therapy, which may last many months or even years, might be restricted to a time period or dollar amount or entirely excluded.

Frequent Exclusions

  • Non-prescription drugs
  • Infertility treatments
  • Birth control
  • Experimental treatments and preventative care
  • Self-inflicted injuries
  • Noncommercial airline travel
  • Cosmetic surgery (most policies do cover cosmetic surgery needed as a result of an accident or congenital defect)
  • Dental expenses (most policies do pay for dental work needed as a result of an accident)
  • Psychiatric care
  • Learning and behavioral issues
  • Care covered by other insurance companies or providers (workers compensation, VA, or other organizations)
  • Injury, illness, or death while committing a crime
  • Vision care and correction
  • Hearing aids
  • Injury, illness, or death while under the influence of alcohol or drugs
  • War related injuries or other health care needs; military service typically suspends the insurance policy

Basic Limitations of Health Insurance

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