Health insurance exclusions

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PostPosted: Thu Feb 25, 2010 3:29 am   Post subject:   

Veronica said:

Some health insurance policies do not cover any illness within 30 days of commencing a policy, except injury arising out of accident.

Excellent point. Many individual medical expense contracts will not cover illnesses for a period of time after the effective date of coverage. This is generally referred to as "probation" and is commonly 7-60 days with 30 days being pretty typical. This waiting period will also apply upon lapse and any subsequent reinstatement. Normally, the probation period allowed by statute is 10 days following reinstatement. You rarely see this in group contracts, but it does exist. The exclusion only applies to illnesses and not to accidents as Veronica noted. The theory behind the waiting period is to prevent adverse selection; a person might easily buy a policy simply because they either know or think something is medically wrong with him. You might know if you're ill, you don't know you're going to get into an accident, hence coverage for injuries and not illness.

Also, some states allow up to a 10-month probation period for maternity. There's another important thing about these probationary periods that should be noted. Say for example that a policy had a 30-day probationary period for illness and the insured suffered a heart attack on the 28th day. The policy will NOT cover the medical expenses associated with the heart attack on the 31st day- the language for these provisions state that "any illness occurring during the policy's stated probationary period will not be covered regardless of the length or cost of that illness even if the illness extends beyond the probationary period."

Good point Veronica.

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PostPosted: Thu Feb 25, 2010 12:37 pm   Post subject:   

Thanks InsTeacher... Smile

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