Out-of-network: refers to physicians, hospitals, or other health care providers who do not have a contract with a person`s health care plan. Depending on the plan, the costs of services provided outside the network may not be covered at all or may require the insured person to pay a higher co-insurance or co-payment rate. Exclusions: Services that are not covered by a person`s plan. Sometimes exclusions are called constraints and both must be clearly defined in the plan documents. Services that include those that people need to live independently in the community, such as home health and personal care, as well as services provided in institutional environments such as nursing homes.