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Exclusion

A clause in the contract denying coverage for specific hazards, people, or property.
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A contractual provision that denies coverage for certain perils, persons, property or locations.
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UK: a peril or contingency specifically excluded from the cover afforded by a policy.
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A term in an insurance or reinsurance contract that excludes the insurer or reinsurer from liability for specified types of loss. An exclusion may apply throughout a policy or it may be limited to specific sections of it. In certain circumstances an exclusion may be limited or removed altogether following the payment of an additional premium.
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An exclusion is a provision in an insurance policy that eliminates coverage for certain risks, people, property classes, or location. Often excluded risks can be covered with additional insurance. For example, the personal automobile policy normally excludes coverage if the automobile is being used for business purposes, but a commercial automobile policy is available. In a commercial general liability policy, discrimination in employment is excluded, but the firm can buy Employment Practices Liability coverage separately.Related to an exclusion is the “conditions” portion of the insurance policy. A condition is language in the policy that qualifies or put limits on the insurance company’s promise to pay a claim. If the policy conditions are not met, the insurer can refuse coverage. Common conditions include giving timely notice of a loss, protecting property from further damage, and cooperating with the company during the investigation of a loss or the defense of a lawsuit.
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Certain causes and conditions, listed in the policy, which are not covered.
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The part of a policy that removes or restricts coverage. Common exclusions to most policies include war, intentional loss, governmental action, etc. All policies contain exclusions, as policies cannot provide coverage for everything in many situations the premiums for coverage would be prohibitively expensive, and some events are rare enough that there is no way to determine the odds of the occurrence happening or how to develop sound rates.

Exclusion list

Office of the Inspector General (OIG) record of providers, individuals, and entities that are excluded from Medicare reimbursement. It includes identifying information about the sanctioned party, specialty, notice date, sanction period, and sections of the Social Security Act used in arriving at the determination to impose a sanction. It is titled List of Excluded Individuals/Entities (LEIE) and may be found at http://oig.hhs.gov/fraud/exclusions.asp . Also called sanctioned provider list .

Exclusion note

Excludes notation that lists a disease or condition with a diagnostic code that indicates it cannot be used when assigning a code from the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) , Tabular List, Volume 1.

Exclusion(s)

1. Provisions written into the insurance contract denying coverage or limiting the scope of coverage. They may be specific hazards, perils, or conditions. In connection with a preexisting condition, it means that the policy will not pay benefits arising from that condition. 2. Department of Health and Human Services (DHHS) and Office of the Inspector General (OIG) penalty imposed on a provider that prohibits the individual from billing Medicare or other government programs. 3. In the Medicare program, services not covered such as eye examinations, foot care, eyeglasses, hearing aids, cosmetic surgery, custodial care, and personal comfort items. Medical practices are required to make patients aware of their financial responsibility for noncovered services through waiver of liability statements. Also called exceptions .

Exclusion/exception

A policy provision that eliminates cover in regard to specified property, persons, perils, forms of damage or particular circumstances. The excluded risks may be uninsurable, require special consideration or readily be ‘bought back’ if required. The exclusions may be general, i.e. across all sections of the policy, or section-specific. The insurer must prove that an exception applies unless the exclusion comes in the form of qualifying words in the operative clause. See QUALIFIED PERILS.

Exclusions

Specific conditions or circumstances listed in the policy for which the policy will not provide benefit payments.
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Specific situations, conditions or circumstances that are listed in the contract as being not covered.

Exclusive agency system

A system of insurance sales, in which agents only provide business to one company or give the right of first refusal to a certain company.
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Method of marketing Insurance through agencies which operate as independent business, but which represent only one Insurer.
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See: Captive agent.