The Guide
Student Health Insurance
Student Health Insurance Exclusions and Limitations
Every insurance company that offers student health insurance will provide you with a list of medical expenses that are not covered under your policy. In addition, they will also disclose other student health insurance covered benefits that have limitations on coverage. This information will be available in your plan brochure under the section named "Exclusions and Limitations." Since health insurance regulations may vary from state to state, the items that an insurance company my exclude or limit can also be controlled by state mandates. Your insurance agent, or the insurance company, should make you aware of the mandates that apply to the state in which you will be attending college. Or, you can also contact your State Department of Insurance for additional information on the health insurance regulations that govern the industry in that state. In evaluating a student health insurance policy, you should also consider the common covered benefits for student health plans.
Since health insurance regulations and limitations can vary from one insurance company to another, and from one state to another, we are listing in this section the exclusions that are common to most student health insurance policies. If an item of specific concern to you is on this list, it does not necessarily mean you will be unable to find an insurance plan that does not exclude these benefits. However, most of the items found here are common exclusions that you will find on every health insurance plan you are considering.
Common Exclusions Include:
- Pre-Existing conditions (Usually for a specified period of time from initial enrollment date)
- Treatment for acne
- Acupuncture
- Treatment of drug or alcohol addiction
- Cosmetic procedures (Unless required as the result of an injury that occurred while you are insured under the health plan)
- Dental and Vision
- Non-severe mental illness
- Congenital conditions
- Self-inflicted injury or attempted suicide
- Elective surgeries
- Elective abortion
- Maternity
- Experimental procedures
- Weight loss procedures
- Hearing aids
- Injuries sustained while playing scholastic sports
- Birth control
- Infertility treatment
- Transsexual surgery
- Injury sustained while participating in dangerous or risky activities
- Sleep disorders
- Medical treatments received outside of the service area
- Medical treatments received before the policy became effective or after it has terminated
- Breast reduction or augmentation
- Treatment of chronic pain disorders
- Speech Therapy
The list of exclusions may be substantial longer on most student health insurance plans, so do not be discouraged. However, you do want to be familiar with these non-covered expenses to make certain that none of them directly apply to your situation.
In addition to specific exclusions, many student health insurance policies may place limitations on other covered benefits. A limitation may refer to the number of office visits allowed per year, or a monetary maximum that the insurance company will contribute toward this covered benefit.
Common Student Health Insurance Limitations Include:
- Out-Patient prescription drugs (If covered, there will usually be a maximum annual payable limit or a specific drug formulary that must be used)
- Preventive health care
- Annual physical exams
- Mammograms and pap smears
- Prostate screening
- Psychotherapy
- Treatment of diabetes
- Emergency dental
- Emergency medical evacuation
- Repatriation
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