Is it legal for my health insurance company to claim an exclusion that does not appear in my contract?

The only place this exclusion appears (according to them) is in their computer when I call customer service.

Asked on November 20, 2014 under Insurance Law, Florida


SJZ, Member, New York Bar / FreeAdvice Contributing Attorney

Answered 6 years ago | Contributor

Insurance policies are contracts: both sides are bound by what they agreed to. They cannot impose or claim a new exemption which was not in your policy/contract unless

1) it was in some other notice you received prior to incurring that expense/needing that treatment/etc. (i.e. you need to have been given notice) and

2) the terms of the policy or contract allow the exclusions to be revised after the contract was entered into.

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