Inclusions and exclusions in individual health insurance

Those eligible for individual health insurance

Almost all employees will provide for group health insurance. However those who aren’t covered under these schemes can go in for individual health insurance schemes. Those who are eligible to seek insurance under these schemes are self employed individuals as well as freelancers. However the coverage and the cost may vary vastly from company to company. Before you apply for a individual health insurance remember to check the plans for the medical services that may covered, the deductible and the co payments outlined in the policy, benefits that would be paid for.

Pre existing conditions may not be covered under the schemes

If you haven’t been covered by any individual health insurance for the past 62 days, then you may be subjected to a 12 month pre existing condition waiting period. Another thing, pregnancy isn’t considered a pre existing conditions. HMO plans for individual health insurance are better than Fee for service since they are more inclusive of benefits provided. However there is some exclusion such as plastic surgery. Unless of course, the plastic surgery has to be done for reconstructive surgery. Therefore the nose job may not be covered under the individual health insurance that you want so much.

Coordination of benefits

There are many individual health insurance plans that may cover the complications of pregnancy but not the process of pregnancy and child birth. Many experimental procedures or non traditional medical methods may not be covered under the individual health insurance schemes. Both you and your spouse may be covered under different individual health insurance schemes, but you won’t be covered for more than 100% of the amount. This means that under both plans you can’t receive more than 100% of the medical expense. This is also known as the “coordination of benefits”. This ensures that the overall costs of the insurance are kept down.

The individual health insurance covers may change at different phases of life

Mental health as well as hearing and vision aids may not be covered under several individual health insurance plans. There may also be separate policies for covering dental expenditure. Remember as you grow in your professional life and in your personal life, your medical needs will change. Depending on the requirements, your individual health insurance cover will also change.