Individual Plan- exclusion question (meaning?)and BMI

My husbands insurance has a written exclusion, so we are thinking about getting an individual plan- the exlusion reads: charges related to “quality of life” or “lifestyle” concerns including, but not limited to: smoking cessation, obesity, hair loss, or cognitive enhancement; charges incurred due to a pre-existing condition until you have been continuously insured for 12 months (unless the condition has been specifically excluded from coverage). So just to spell it out- does that mean it WOULD be covered if deemed medically nessasary?

Also, I applied for a different insurance plan a while back and was declined due to my BMI. I've lost some weight since then, and I was wondering if anyone knows what the highest BMI is that MOST companies will accept. I know that since most of you don't work for the insurance company it isn't going to be 100% accurate, but just a general rule.

Thanks!!

If I were you, I would check with your husband's insurance company's customer-support department to get clarification on this particular exclusion.  The exclusion might apply to bariatric surgery, but it also just might be referring to weight-loss programs such as Weigh****chers, Slim Fast, the Atkins Diet, etc.  Services such as these are not typically covered by health-insurance plans.  Bariatric surgery might very well be covered, or there might be more information in some other spot in your plan description that specifically speaks to bariatric surgery.

Again, contact customer support or even your husband's human-resources department.

I hope I was able to provide some type of assistance for you.

Xavier Derico

Not a 100% sure but you might want to call your insurance and asked but if you were insured before getting a new insurance like if you were insured through your husband's insurance the pre-existing cause might not apply to you.I think it applys to people who don't have insurance and then get insurance have to wait a certain amount of time before certain coverage can start. hope this makes this sense.

Xavier- Thanks! I think I'm just going to have to call the insurance company.

Kimberly-  I have insurance through my husbands employer right now, I'm looking for an individual (not group) plan that covers the surgery. Since I'm covered right now,  and have been for the past several years, pre-existing conditions don't apply. I'm covered under HIPPA. Its the exclusions that worry me- I don't want to get a plan that has the surgery specifially excluded- like my current insurance does. Thank you though!

Thanks again! Anyone else have any insight?

Some insurance have a 30 day trial where you can cancel without a cost before the 30day. What I did when I got my second insurance to cover weight lost is as soon as I got my member ship card I called to see if it was a covered benefit under the plan. I canceled one within 2 days because it wasn’t covered. I’m in the process of obtaining a new insurance an individual plan as second coverage to cover the wls. I’m just waiting on getting a second job because the premiums are so high. Good luck hope I was some help.

Kimmy you need to call your insurance company, look on the back of your card and call the customer service number and ask them if weight loss surgery is covered under your contract. 

Looking for a indivdual policy will not solve your problems as individual policies with insurance companies automatically exclude weight loss surgery or obesity peroid.  Your only shot is through basically group insurance.

The paragraph you reference leads me to believe its an exclusion but check with the insurance company that paragraph is not really related all the situations to pre existing its just saying including pre existing.