Health insurance exclusions: definition of exclusions and examples
Insurance companies are allowed to place exclusions when they accept applications for supplemental insurance. But what does that mean exactly? Here’s an example.
10.08.2022
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1. Health insurance exclusions: definition
Health insurers are not obliged to accept your application for supplemental insurance. Health insurers may therefore reject applications or place temporary or permanent exclusions upon acceptance.
An exclusion means that certain benefits in connection with a particular illness are not provided. This means that you will have to pay for treatment for an illness listed in the exclusion yourself. Health insurance companies use exclusions for people they consider to be an unfavourable health risk.
2. Example of a health insurance exclusion
Imagine you suffer from hay fever. You then apply for supplemental insurance that covers alternative medical treatment. The health insurance company applies an exclusion for the treatment of hay fever when you take out this supplementary insurance.
This means that the supplemental insurance does not pay for the treatment or effects of hay fever. If you seek out treatment for hay fever from a natural health practitioner, you must bear the full costs yourself.
Don’t forget that certain benefits are also covered by basic insurance. A doctor trained in conventional medicine who is trained in one or more of the alternative treatment methods subject to statutory health insurance, such as acupuncture or herbal medicine, may invoice the treatment under basic insurance.
3. When are retroactive exclusions possible?
With supplemental insurance, health insurance providers have the right to make retroactive exclusions, for example if you provided false or incomplete information when filling out the insurance application.
This article was first published on 10.08.2022
