What does Exclusion mean?

I have Cigna, and I have talked to them, and I just recently requested a copy from my hubby's employer our policy...in the back there our exclusions what does that mean? Surgery is one of them along with a long list of others? However when I spoke to the Cigna Rep. they said they covered it as long as it is medically neces. Of course you have to jump through a bunch of hoops. Thanks, Elizabeth

An exclusion means that the policy that your husband's employer purchased for their employees does not cover it. I always compare it this example: it's like you have home insurance that "excludes" flooding. If your house burns down, you're fine. But if your house floods, you're in trouble. Cigna offers insurance that includes surgery, but your husband's company chose not to buy it. (They get a less expensive rate when they buy health benefits for their employees that exclude certain things.) The problem is that if you call Cigna and ask whether they cover surgery, they may tell you "yes" because technically, they do...but often times, the representatives at insurance companies don't understand that they should be checking your specific policy before they answer. They get confused as well, because they've been taught that Cigna pays for weight loss surgery. But what they don't think about is that there are companies that aren't purchasing that particular part of their insurance. There have been a lot of people on this site who have been told incorrectly by the insurance company that weight loss surgery is covered...only to find out that it isn't. (I think the insurance company's computer systems are notoriously bad when it comes to benefit details.) Basically, your husband's company is giving you a bum deal. (...assuming that there is an exclusion---make sure you double-check.) They can claim to offer health benefits to their employees, but then exclude a bunch of stuff in the fine lines. It's frustrating! And you're not alone weight loss surgery exclusions are very common, and seem to becoming more and more common. All hope is not lost though. Sometimes you can get a "rider" this means that you might still be able to get it covered by paying something additional. I'm not entirely sure as to how it works. Someone else might be able to describe it better. I know that there are also some cases where people have been able to get it covered after getting a lawyer. Also, there are some states that are beginning to enact laws about these kinds of things. You might want to do some additional research. You may also consider writing to your husband's Human Resources department about the quality of the benefits that you are getting. Ask them whether they would consider including at least one of their plans that covers weight loss surgery...even if the premiums are higher. The problem is that health benefits are getting so pricey these days, that companies are doing everything they can to save money. If they offered health benefits that excluded cancer treatment, for example, can you imagine how outraged everyone would be?!! But unfortunately, they get away with excluding treatment for morbid obesity, and no one cares. Just more proof that discrimination against obese people is tolerated. To be fair, it's partially the fault of insurance companies as well for allowing companies to purchase cheaper plans by writing in exclusions. Some companies may not even be aware...the insurance companies offer them a wide variety of options to choose from, and they select the least expensive policies that are often the policies that exclude whatever they think they can get away with. Anyway, I hope this helps you understand it a little better. These things can be so confusing. Good luck! Fight for your rights!