5 things your medical policy won’t cover

May 6, 2014

Believe it or not, every medical insurance package comes with exemptions which can vary from just one or two simple scenarios to a detailed and complex checklist of exclusions.

 

By Joshua Ong
As costs of medical care increases with alarming speed; many people are scrambling to buy insurance packages to cover the costs should the need arise. But what does medical insurance provide you? To put it simply, being under medical insurance coverage is akin to walking around with a giant invisible umbrella. If you break your leg in an accident tomorrow, you don’t have to panic and worry about medical costs, all you have to do is lie back and relax on your hospital bed while your insurance company takes care of the associated costs. Sounds like a good deal right?
Unfortunately, insurance companies don’t always cover everything. Within the mass of mile long terms and conditions associated with every medical insurance package lies a discrete list of coverage exemptions. Believe it or not, every medical insurance package comes with exemptions which can vary from just one or two simple scenarios to a detailed and complex checklist of exclusions. So don’t set yourself up to be tricked, read on for our list of the five most common medical insurance exemptions.

1) Pre-existing conditions
More formally, a pre-existing condition is a medical condition that has occurred before the insured person began his/her medical insurance coverage. Pre-existing conditions are not covered by all medical insurance companies. So for example, if you were diagnosed with a terminal heart condition today and decided to sign up for medical insurance tomorrow then your heart condition would be considered a pre-exisiting condition and will not be covered by the insurance company.
But that’s not all; there have been cases where symptoms of a pre-existing condition have manifested but because tests were not done and conclusive findings sought, the insured didn’t know of the illness and yet the insurance company sought to have the claim dismissed on the grounds that it was pre-existing. The truth is; insurance companies aren’t in the business for their health (or yours for that matter!), they’re in it for the money so don’t get hooked by a smooth talking agent and jargon-filled policy.

2) Plastic surgery


Thinking about having your medical insurance cover your latest nose job? Well think again! Whether it be chin implants, face lifts, tummy tucks, boob jobs or butt jobs, all these modifications (while expensive) are not covered by medical insurance.
Plastic surgery is generally considered an optional medical procedure and not a life-saving one. Always remember that medical insurance companies only cover conditions where medical attention is absolutely necessary and not situations where surgery is a luxury and/or can be entirely avoided.

3) Any claims within 30 days
If you purchase a medical insurance package today, it doesn’t mean that you are covered immediately. While this may surprise you, medical insurance companies normally have a so called “cooling off” period right at the start of your coverage where you cannot make any claims whatsoever. The period usually lasts around 30 days from the time that your coverage has begun. However, depending on the company, the time period may fluctuate.
Medical insurance companies do not implement the “30 day rule” to screw you over. The sole purpose of this rule is to protect the company from fraudulent claims by insured candidates who may have lied about pre-exisiting conditions in their application forms.
While this rule may seem like a travesty, there are extreme exceptions to the “30 day rule”. For example, any incidences involving accidental injury (such as vehicle collision injury) might still be covered by some medical insurance packages. To be absolutely sure, you should always ask your medical insurance provider to clarify when your coverage actually begins and whether there are exceptions during the interim period where you are not provided with any coverage.

4) Dental trips


While it may be important to visit the dentist once every 6 months, don’t expect your trip to be covered by your medical insurance company. Similar to the case of plastic surgery, most medical insurance companies view dental visits and their typically associated procedures such as scaling and polishing for example, as a cosmetic expense and not a matter of life or death.
Though there is one clear exception to this rule, if the surgery pertains to a major medical condition such as an infected wisdom tooth or serious gum disease, then your medical insurance company might cover the cost. However, there are some medical insurance packages on the market that do not cover dental visits at all, no matter how severe the case! To avoid landing yourself in such a sticky situation, always ask your medical insurance officer whether the package you are interested in covers emergency dental visits and to what extent.

5) Claims made while breaking the law
Got injured while robbing the bank? Call the ambulance but don’t call the medical insurance company, because they will not (under any circumstance) provide you with coverage if you get injured whilst breaking the law.
Medical insurance companies are designed to be there to cover you in your time of need, like when you get hurt or sick under accidental circumstances. If you role play as Jessie James and run off on a robbery rampage, then the medical insurance company (and probably society) will turn their back on you.

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