Health Exclusions, Limits, and Renewability

What this video covers

• How an exclusion removes a service or circumstance from coverage, while a limit caps a benefit by amount, duration, visits, or occurrence
• How an insurer’s benefit maximum differs from a member’s out-of-pocket maximum, and whose payment each one caps
• Why a limited-benefit policy is not a substitute for comprehensive coverage, and when essential health benefits have dollar-limit protections
• How pre-existing-condition restrictions differ from excluded services, and which comprehensive plans cannot impose those restrictions
• What noncancelable, guaranteed renewable, and cancelable mean for continuation and premium changes
• How to calculate an insurer payment by separating covered charges, applying the deductible, then applying coinsurance
• How to check coverage category, exclusions, limits, and renewal language when analyzing a claim