Limits and Exclusions

Child being given polio vaccine

When it comes to health insurance it is always of utmost importance not just to know the benefits but also the limits and exclusions.

Limits refer to the maximum amount an insurance company  will pay to cover for health services of an individual. Most companies have a lifetime limit though some have an annual limit (usually job-based plans). What this means is that as soon as the limit is reached the insured person will no longer receive any of the benefits listed on the health insurance policy. There are also specific limits for some covered services, which sadly usually are the ones that incur a really large bill (i.e. chemotherapy, dialysis, etc.).

Exclusions, on the other hand, are services that are automatically not covered by the insurance policy. Some exclusions may be general, since the insurance policy is cheaper and does not cover a lot of things, or may be specific to an individual due to pre-existing conditions. Make sure you know the exclusions so that you can purchase a “rider” that will cover even your pre-existing condition, if available and/or allowed.