What is a plan exclusion?

A plan exclusion is a condition, treatment, or service that is excluded from coverage under a health insurance plan in Florida. This means that the plan will not pay for, or will only partially pay for, any associated costs. Health insurance plans can also include exclusions based on the type of service or provider, such as providers who are out-of-network or those who provide treatments considered to be experimental or controversial. Plan exclusions are not designed to limit access to care, but rather are intended to protect the plan from covering services that are deemed to be either unnecessary or ineffective. Additionally, plan exclusions are intended to ensure that a plan’s premium costs are reasonable and will not adversely affect the costs for other enrollees. By excluding certain services from coverage, the plan is able to provide care with fewer resources, allowing it to lower premiums.

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