Exclusions are those conditions in any insurance policy documents that lists the conditions under which the insured would not reimbursed even if they file claims.
Exclusions are generally listed as a separate section in the policy certificate but in some cases, they can be distributed in various parts of the document. Look at the list of exclusions which is given in the policy brochure or the certificate. If the list is long, then it is mostly comprehensive. If it is not lengthy, then expect other exclusion conditions to be spread throughout the paperwork.
Many of the exclusions listed in family and individual health insurance plans are common. Some of the routine exclusions mentioned are as follows
- Dental care
- Aids – hearing, vision
- Convenience items like cough syrup and humidifiers
- Extra pillows, TV, telephone facility during hospitalization
- Private nursing care
- Abortions by choice
- Cosmetic surgeries
- Experimental treatments
- Non-prescription drugs (dietary supplements that have not been prescribed by a certified doctor)
Hence, before finalizing a health insurance plan for your family needs, you need to aware of what benefits you are eligible for and what conditions you would not be covered
Once you finalize your health insurance plan, it is important to choose your doctor who would provide the required health care services. This is a very important step as the expertise of this medical professional can have a direct impact on the quality of your life in the future.
Perform research on the credentials of the doctor. His experience and past performance is very important. Ensure that he deals with patients of all age groups and he has a good network of specialists who he can refer to in case required.
HMO and PPO plans give you a list of doctors associated with the network. If you consult a doctor out of this network, you may not get the full reimbursement for the expenses incurred. Similarly, in case you buy a family health insurance plan without a medical network, the premiums generally cost you higher.
However, in case of serious illness, this extra cost should not be considered as a good medical consultation is worth the extra expenses for the right diagnosis at the right time.
A PPO (Preferred Provider Organization) is a health care system managed by a set of hospitals, clinics and medical experts who provides services only to a specific association or group. It is generally funded by an insurance company or employers or some type of an organization.
The physicians associated with a particular PPO network provide medical consultation at subsidized rates to the employees, policyholders as well as sponsors. In turn, the policyholders also get benefited by enjoying discounts if they consult a medical professional associated with the PPO network.
Many insured individuals always ask a common question: whether they can visit any medical set-up outside the PPO network even if the list hospitals, clinics and professionals tied to the insurance provider are mentioned.
Irrespective of which international health insurance policy you purchase, you can consult any medical professional of your choice or visit any hospital. The difference lies in the amount of reimbursement that you would get from the insurance provider.
Generally, the insured enjoys maximum benefits for any claims filed if he or she seeks medical help within the PPO network. Otherwise, the percentage of reimbursement varies from insurance company to another.
The coverage benefits of international visitor health insurance plans vary depending on the type of policy as well as the coverage limits. Though there are some standardized benefits offered by almost all health insurance plans, if you are looking for specific coverage like war, terrorism, epidemics, hazardous activities, pandemics, trip interruption, you need to look out for health care coverage for these special instances.
The swine flu outbreak was announced during the last week of April 2009. When panic spread, it became quite problematic for people to get health insurance coverage for any expenses incurred due to the disease. Not all insurance providers were willing to offer coverage for such a widespread epidemic.
However, when tourism was hugely affected in Mexico, it was decided that all tourists visiting the country for vacation during this epidemic would be given free health insurance coverage in case of swine flu when they check-in to specific hotels! This was one of the first times when the government took such a step to attract visitors to the country.
In case you are planning a vacation under such circumstances, it would be a good idea to buy trip cancellation insurance in order to get reimbursement in case it gets cancelled or postponed.
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