Insurance Policy Limitations and Exclusions

While benefits, limitations and exclusions may vary from policy to policy, there are some basic rules related to limits on your policy that you should be familiar with. Understanding what your policy doesn't cover is just as important as knowing what it does cover.

Be sure you have an updated benefit booklet (also known as an evidence of coverage and disclosure form). At the front of the booklet, you will find a reference table which provides you with a quick overview of your policy. It will list not only your benefits but any restrictions related to a specific benefit.

While the table acts as a quick reference, by referring to the table of contents in your evidence of coverage booklet, you will be able to find the section which provides greater details of your benefits and any restrictions associated with your benefits. Be sure to read the sections which outline "limitations", "exclusions" and "definitions".

Medical Necessity

Custodial Care

Lifetime Maximum

Other Limitations You Should be Aware Of


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