Exclusions

Exclusions are services, conditions, or expenses that your health or dental plan does not cover under any circumstances. Every policy contains an exclusion list to define what falls outside the scope of coverage. Common exclusions include cosmetic surgery, over-the-counter medications, experimental treatments, fertility procedures, and any service not deemed medically necessary.

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Understanding exclusions is essential because they determine the boundaries of your protection. Knowing what is not covered helps you plan out-of-pocket expenses and avoid surprises when submitting claims.

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Example:

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If your plan excludes cosmetic procedures, expenses for elective teeth whitening or Botox injections will not be reimbursed.

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What to Watch For:

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Review your plan booklet for the full list of exclusions. Even medically necessary services may be excluded if performed outside Canada or by an unlicensed provider.