Short Term Health Insurance - Common Exclusions and Limitations
When reviewing your many options in choosing a short term health insurance plan, you will notice that all of them have many exclusions and limitations. These exclusions may seem unreasonable, but they are common on most temporary health insurance policies. Since health insurance is state regulated, the insurance companies may be restricted as to the types of benefits that they can exclude. Your short term health insurance policy should meet the exclusion and limitations as governed by the state in which you reside. Below is a list of exclusions common to temporary health insurance coverage. These may vary from state to state or from one insurance company to another.
Services that are not considered medically necessary are most always excluded. These would be such services as elective surgeries, cosmetic procedures, and alternative preventive treatments.
Pre-existing conditions are also commonly excluded. A pre-existing condition is defined as a medical condition that was previously diagnosed by a licensed health practitioner within a specified period (usually 6 months) immediately preceding the effective date of coverage. This would include any medical advice, diagnosis, care, or treatment as well as the use of prescription drugs for treatment of an illness. Some policies may also consider a manifest illness as a pre-existing condition. A manifest medical condition is one that existed prior to your requested effective date of coverage even if you were not aware of this condition or had not received any medical treatment for it. If your short term health insurance company excludes manifest pre-existing conditions, it should be clearly stated within your policy terms. The number of months a pre-existing condition will be excluded under a temporary health insurance policy is often defined by the pre-existing condition exclusion period.
Benefit payments that would exceed the maximum benefit amount as outlined in the description of your coverage. All short term health insurance policies have maximum benefit limits. These are commonly $1 million or $2 million, but may vary based upon insurance company and price options available.
Convalescent or rehabilitative care, or care primarily for rest, change of environment, custody or maintenance , nursing homes, convalescent homes or extended care facilities are typically excluded because they are common treatments associated with long-term care. Short term health insurance policies do not consider this a benefit for which they would need to be responsible.
Dentistry and dental appliances, except as provided for under covered expenses, are not benefits on most temporary health plans. These benefits are typically expected to be covered under a separate dental insurance plan.
Cosmetic surgery, vasectomies or tubal ligations, intersex surgery or its complications are among the list of exclusions on most short term health insurance plans because they are not deemed medically necessary.
Health care provided before or after the short term policy term are usually not covered. Once your policy expires, your benefits will end immediately unless your policy offers an extended benefits option. Routine physical examinations and related services that are also not medically necessary will be excluded, as will other preventive treatments such as well-baby care, well-child care, or adult and childhood immunizations.
Almost always, you will find a clearly stated exclusion on your short term health insurance plan for any services that are maternity related. Some states prevent insurance companies from excluding treatment for complications due to a pregnancy. If your state prohibits this exclusion, it should be outlined in the temporary insurance policy benefits description you receive from your insurance company.
Routine eye exams, eyeglasses, contact lenses or eye refractions are also commonly found exclusions.
Injury or sickness covered by workers' compensation is not part of the benefits you will receive with most short term health insurance plans. This is because such expenses are usually the responsibility of your employer or their worker's compensation insurance carrier.
Attempted suicide or self-inflicted injuries such as charges resulting from the intentional use of poison, gas fumes, intoxicants, narcotics or hallucinogenic drugs not prescribed by a physician are also on the list of things that a temporary insurance carrier feels they are not responsible for treating. Services that are experimental or investigative in nature are often excluded because they have not been deemed a medically acceptable form of treatment.
Treatment incidental to sexual dysfunction, infertility, in vitro fertilization, genetic testing, artificial insemination, egg donation or receipt are also considered elective treatments that would fall into the category of not being medically necessary.
For additional information about short term health insurance policies, review the Short Term Health Insurance page. Additional information of interest can be found in the frequently asked questions section or under covered benefits.
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