FYI: Stuff You Should Know about Insurance

The policy document is the most important part of your insurance package. It shows the details of the insurance you have bought. Read your policy document carefully to make sure you understand exactly what is and isn't covered. Here are some details about what kind of information you will find in each section:

Benefits: This section lists services and expenses that are covered under the policy, with a precise explanation of what each benefit means. Some benefits and services have lower coverage limits or need to be approved by the insurer before you get them. Make sure you check this section before receiving any medical care (procedure or service) to be sure it is covered. Anything that is not listed in this section will not be paid for by the insurance company.

Definitions: This section is extremely important, as it gives you the exact meanings for certain terms used throughout the policy. The words in your policy follow the meanings written in this section, even if it's different than the way you understand the word. Make sure you understand the terms that are important to you, because these definitions will largely determine how any exclusions or restrictions apply to your situation.

Eligibility: This tells you whether or not you can buy the plan. You may need to be within a certain age range or satisfy certain medical criteria to qualify for a plan.

Exclusions: This section familiarizes you with the situations where benefits would not be paid by the insurance company. Important exclusions to look for are ones about medical conditions you had before you bought the insurance and particular activities (such as extreme sports) that may not be covered. Some exclusions appear in almost every policy, especially ones about illegal actions or drug abuse, but every policy is different.

Restrictions or Limitations: This section may be part of the Exclusions or Terms and Conditions, or it may be separate. It describes certain situations in which benefits have rules or limits. For example, procedures like major surgeries may need to be approved by the insurer first, or you may have to notify the insurance company within 24 or 48 hours of admission to a hospital.

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