What is an exclusion? | healthinsurance.org (2024)

FAQs

What is an exclusion condition? ›

A diagnosis of exclusion or by exclusion (per exclusionem) is a diagnosis of a medical condition reached by a process of elimination, which may be necessary if presence cannot be established with complete confidence from history, examination or testing.

An exclusion is a provision within an insurance policy that eliminates coverage for certain acts, property, types of damage or locations. Things that are excluded are not covered by the plan, and excluded costs don't count towards the plan's total out-of-pocket maximum.

In a nutshell, an exclusion is a condition or instance that is not covered by your insurance plan. Just as each plan has a list of items that the insurance company will cover, they also have a list of items they will not.

An exclusion is an event (peril, accident, incident, or accusation) that an insurance policy will not cover. A standard insurance policy will typically include some exclusions. While insurance policies help small businesses mitigate risk, they don't cover everything.

People can be excluded because of who they are, where they live, sociocultural reasons, lack of resources – and frequently a combination of these factors, as shown in Figure 1.2. The overlapping circles in the diagram indicate how there may be more than one reason for exclusion of any individual or group.

There are Two Types of Exclusions: Mandatory and Permissive.

A good example of social exclusion is when a group of people is marginalized or excluded from participating fully in social, economic, or political activities because of their race, ethnicity, religion, gender, sexuality, or socioeconomic status.

An insurance exclusion specifies which events your policy won't cover, essentially narrowing the scope of coverage. These exclusions help insurers avoid risks they find too high or unpredictable. Sometimes, your policy only lists the perils it covers, meaning everything else is automatically excluded.

A benefits payable exclusion is a legal clause indemnifying an insurer against claims relating to employee benefits. These types of claims are regarded as an uninsurable business risk. In practice, courts will sometimes require insurers to cover such claims even if a benefits payable exclusion clause is in place.

Injuries and sicknesses resulting from war are excluded. Any injury that is self-inflicted is excluded. Work related disabilities may be excluded and receipt of workers compensation benefits may render an insured ineligible for benefits under a typical disability income insurance policy.

What is exclusion in healthcare? ›

Health care services that your health insurance or plan doesn't pay for or cover.

“Exclusion consists of dynamic, multi-dimensional processes driven by unequal power relationships interacting across four main dimensions—economic, political, social and cul- tural—and at different levels including individual, household, group, community, country and global levels.

To see how we exclude, we have to learn to see whose voice is missing, learn to be open to understanding different perspectives, and create space for plurality. In addition to recognizing exclusion, we also have to learn how to be attentive and listen to people when they feel excluded.

Exclusions are specific situations or circ*mstances which are not covered by a particular policy, while exceptions are specific situations which are covered by a policy, even if they would normally be excluded.

A diagnosis of exclusion is an expression that in general applies to that diagnosis that is left over after all other possible differential diagnoses have been excluded.

An exclusion rider generally states that benefits are not payable for disability resulting from or related to a specified medical condition (e.g., asthma), from a disease or disorder of an area or part of the body (e.g., the cervical spine), or injury sustained while participating in a specific activity (e.g., rock ...

An escalation clause, or escalator, is a section in a real estate contract that states that a prospective buyer is willing to raise their offer on a home should the seller receive a higher competing offer.