What to Expect from Your Health Plan: Covered Services and Exclusions
Getting health insurance is a wise step, but understanding your plan is just as important. To make the most of your coverage, you need to know what’s included, what’s excluded, and how to use your plan effectively.
Covered Services
Most HMO plans offer a wide range of services aimed at keeping you healthy and protected. These typically include:
- Outpatient consultations
- Inpatient care (hospital admission and surgery)
- Laboratory and diagnostic tests
- Prescription medications
- Emergency care
- Preventive services (e.g., immunisations, screenings)
- Maternity care
- Specialist referrals
HallmarkHMO provides access to these services across a wide network of hospitals and clinics, ensuring convenience and prompt care.
What May Be Excluded
Every plan has exclusions to avoid misuse and manage costs. Common exclusions include:
- Cosmetic procedures
- Experimental or unapproved treatments
- Chronic condition management (in basic plans)
- Self-inflicted injuries
- Treatment outside the plan’s hospital network
Always review your policy documents or consult with your HMO provider to understand these limits.
- Tips to Maximise Your Coverage
- Use designated hospitals within your HMO’s network.
- Keep your health card and ID handy during visits.
- Follow referral procedures to avoid delays or denials.
- Attend regular check-ups to catch issues early.
Understanding your health plan empowers you to make smart decisions, and get the care you deserve.
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