Author
Bowtie Team
Updated on
2025-06-12
Disclaimer: This article is translated with the assistance of AI.
Medical insurance helps cover your healthcare costs, but outpatient services, childbirth, and dental visits are often left out. Discover the reasons why from Bowtie’s insurance experts – and how to protect yourself!
What Medical Insurance Doesn’t Cover Outpatient, Childbirth, and Dental Care
Taking the current mainstream medical insurance — VHIS as an example, policies usually do not cover:
- General Outpatient: for example, visiting a private clinic or hospital outpatient department for conditions like the common cold, flu, or gastroenteritis
- Childbirth: Pregnancy and related complications are generally not covered, including prenatal checks, delivery, miscarriage, and termination of pregnancy
- Dental Care: Routine dental treatments, such as teeth cleaning, root canals, fillings, and wisdom tooth extraction
However, in certain cases, some Outpatient and Dental procedures are also covered under VHIS:
- Outpatient services before and after hospitalization or day surgery
- Emergency outpatient treatment for accidents*
- Outpatient Kidney dialysis (hemodialysis)
- Outpatient-performed Specified diagnostic imaging tests , such as CT (computed tomography), MRI (magnetic resonance imaging), and PET (positron emission tomography)
- Emergency treatment surgery due to accidents (such as a tooth fracturing from a sudden impact) during hospitalization
- * Applies to Bowtie VHIS Flexi Plan and Bowtie Pink VHIS.
Why Medical Insurance Excludes Outpatient, Childbirth, and Dental Care
You might be thinking, since you’re paying for medical insurance, you’d want a ‘full package’ that covers everything for the best protection. So why do medical insurances, including VHIS, generally exclude standard outpatient services, childbirth, and dental care? There are mainly two reasons behind this.
Medically Necessary
Medical policies typically specify that any surgery or treatment costs eligible for reimbursement must be medically necessary.
Different insurance companies might interpret ‘medically necessary’ slightly differently, but they generally consider factors like whether the condition is critical, if hospitalization is urgent or essential, if it’s for treatments or surgeries that are absolutely required, if the treatment could be handled on an outpatient basis, if it’s difficult to perform without admission, or if hospitalization is solely for symptom checks without actual treatment .
In other words, if the consultation and care aren’t truly necessary, are just for convenience or comfort, or are purely preventive, those services might not meet the medically necessary criteria.
Fairness Considerations
Medical insurance needs to strike a balance between ‘product appeal’ and ‘long-term affordability of premiums’. Insurers want to expand coverage on one hand, but on the other, they must factor in risks, costs, and premium levels.
People typically visit clinics for doctor check-ups or dental offices for cleanings and fillings far more often than they do for hospital surgeries, and the former is more prone to overuse. As for excluding childbirth and pregnancy-related services, it’s mainly because pregnancy is somewhat predictable and plannable.
If policies covered outpatient, childbirth, and dental services all at once, it might seem like a win-win—customers get more comprehensive protection, and insurers boost their product’s competitiveness for better sales. But remember, as the saying goes, ‘the wool comes from the sheep’ , and in the long run, premiums could become unaffordable.
How to Get Coverage for Excluded Services
How to Get Outpatient and Dental Coverage?
Bowtie offers perks for existing VHIS customers! Bowtie now provides all Bowtie VHIS customers with the BowtieGo healthy living membership program BowtieGo , allowing VHIS customers to enjoy network services—including general practitioner, traditional Chinese medicine, acupuncture, and physical therapy consultations—at exclusive member rates, easing everyday medical burdens.
How to Get Childbirth Coverage?
On the market, only a handful of medical insurance plans offer coverage for childbirth or pregnancy complications , but the premiums are steep, so whether it’s worth it is up for debate.
Get Covered Now and Enjoy Exclusive Offers!
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