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Exclusions and Limitations: Reading the Fine Print

​Understanding what your policy doesn't cover is just as important as knowing what it does cover.

Every health plan includes a section with exclusions and limitations. This is a list of medical services and equipment your health plan will not pay for (i.e. the fine print). It is worth taking the time to read this section all the way through to save yourself from any unpleasant surprises while you file an insurance claim.

Services Typically Not Covered in Managed Care Plans

While benefits, limitations and exclusions may vary from policy to policy, there are some services often excluded from coverage. Check your plan for specifics. 

Many managed care plans also have general exclusions, such as services or supplies that are not medically necessary or for which there are no accepted standards of medical practice.

​Are there limits on what the plan will pay for?

All plans limit some services, such as mental health care and home health care. If your child needs services that are limited by your plan, you should seek advice from your pediatrician.

Have Additional Questions?

If you have questions, talk to a representative of the plan. If your plan is through your employer, talk to the personnel or benefits manager. Services covered by the plan may change periodically, such from one benefit plan year to another. Review your plan at least annually. Do not assume that a service will be covered. Be certain it will.

Last Updated
American Academy of Pediatrics (Copyright © 2013)
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.
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