What types of expenditures are commonly excluded under major medical expense plans?

Although providing very broad coverage, most plans typically contain a number of exclusions. Common exclusions include medical expenditures arising from:

  • Cosmetic surgery unless required to correct a condition resulting from an injury or a birth defect
  • Occupational injuries and illnesses that are otherwise covered under a Workers’ Compensation law
  • Routine dental and vision care (care required for treatment of an injury and dental and eye surgery are frequently covered, however)

Other common exclusions relate to benefits provided by government agencies (e.g., VA hospitals) and expenses paid under other insurance programs, including Medicare and Personal Injury Protection Coverage under your Personal Automobile Policy.