What Do You Mean It's Not Covered: Common Provisions of the Policy Forms

Most health insurance policy forms contain many of the same definitions, limitations, exclusions and general provisions. Rather than duplicate these standard provisions in separate policy forms, we will review the most common provisions first in this chapter. Then we'll review selected policy provisions from a Basic Hospital Expense Policy and a Major Medical Expense Policy in succession. While we won't review managed-care plans (HMOs and PPOs) or group master policies, most of the same issues we discuss and much of the specific language apply to those forms of health insurance. Where applicable, we'll look at case studies that involve them.