Health Insurance California >> Health Insurance >> Not Covered in Health Insurance

What Is Not Covered?

While HMO health benefits are usually more comprehensive than those of traditional fee-for-service health plans, no health plan would cover every medical expense.

Very few health insurance plans cover eyeglasses and hearing aids as these are considered budge-table expenses. Very few health insurance plans cover voluntary cosmetic surgery, except to correct injure caused by a covered accidental injury. Some fee-for-service health insurance plans do not normally cover checkups. Procedures that are considered experimental might not be covered either. And some health insurance plans cover complications arising from pregnancy, but do not cover normal pregnancy or childbirth.

Health insurance policies often bar health coverage for preexisting conditions, but, as explained, federal law now limits exclusions based on such conditions.

You should also remember that health insurers would not pay duplicate health benefits. You and your spouse might be covered under a health insurance plan at work but, under what is known as "coordination of benefits" provision, the total you could receive under both health insurance plans for a covered medical expense cannot exceed 100 percent of your allowable cost. Also note that if neither of your health plans covers 100 percent of your expenses, you would only be covered for the percentage of coverage (for example, 80 percent) that your primary health plan covers. This provision benefits everyone in the long run because it helps you to keep costs down.

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