medical expense insurance
medical savings accounts
medical savings accounts were created to help employees of small employers, as well as self-employed individuals, pay for their medical expenses. Msa's are tax-free account set up with financial institution such as Banks and insurance companies. Qualified medical savings accounts are available for employers with no more than 50 employees
pre-existing conditions
most policies contain a benefit limitation on pre-existing conditions. Limitations apply to all pre-existing conditions whether or not the insured declared them on the application. Unlike the impairment writer, the exclusion or pre-existing conditions is subject to the time limit for certain defenses.
Health reimbursement Arrangements
Health reimbursement arrangements are employer-funded, tax-advantaged health benefit plans that reimburse employees for out-of-pocket medical expenses and individual health insurance premiums. unused amounts may be carried forward for reimbursement in future years. Reimbursements maybe tax free if the employee paid for qualified medical expenses or a qualified medical plan. Health reimbursement Arrangement must be established by the employer.
deductibles,
a deductible is a stated initial dollar amount that the individual insured is required to pay before insurance benefits are paid. Deductibles are used primarily to help control the cost of premiums and reduce over utilization of Medical Services. the term deductible is used most frequently with major medical insurance policies. There are three kinds of deductibles, flat, quarter, or integrated.
basic medical expense plans
basic medical expense insurance is sometimes called first dollar insurance. Unlike major medical expense Insurance, it provides benefits upfront without having to satisfy a deductible. Basic medical expense policies classify their coverages according to General categories of Medical Care, Hospital expense, surgical expense, Physicians expense. Basic medical expense Insurance typically has lower benefit limits than major medical insurance. The benefits provided by basic medical expense Insurance are lower than the actual expenses incurred a particular fee charged by a physician or other health-care, and reasonable expense
major medical expense plans they offer broad coverage under one
benefits for reasonable and necessary medical expenses, subject to policy limits comprehensive coverage for Hospital expenses room and board and miscellaneous expenses, nursing Services, Physician Services Etc catastrophic injury or illness. And have large benefit maximum. coverage is provided for both inpatient and outpatient hospital expenses. Hospice benefits under a major medical plan normally includes coverage for pain management, Home Based Services, and counseling. The list of prescription drugs covered by a pharmacy benefit is called a drug formulary. major medical expense insurance usually picks up where basic medical expense Insurance leaves off in one of two ways, as a supplement to a basic plan or as a comprehensive stand-alone plan.
internal limits
certain types of expenses may have limits placed on the dollar amount of certain services or on the type of service provided. For example, the policy will only pay for a semi-private room, not for a private room, or it will pay only medical expenses that are usual and customary or it will pay lifetime alcohol or drug rehab expenses only up to $10,000 or 45 - 70 days
coinsurance
coinsurance is another characteristic of major medical policies. It is a sharing of expenses by the insured in the insurer and its purpose is to reduce over utilisation of the coverages. After the insured satisfies the deductible, the insurance company pays a high percentage of the additional expenses usually 75 or 80%, and the insurance pays the remainder.
coinsurance continued
coinsurance requires the insured to participate in the payment of expenses. Typically the percentage of payment participation required of the insured is 20% and the insurance company pays 80%.
flat ductable
instead of dollar amounts that applies to a covered loss. This deductible is applied per occurrence, per insured individual. Sometimes referred to as an initial deductible.
comprehensive Major Medical
combines the features of basic expense coverage and major medical coverage, sold as one policy. Cover practically all medical expenses, Hospital, physician, surgical, nursing, drugs, laboratory tests Etc . comprehensive major medical policies include a deductible usually a single deductible per person and per family, but Corridor deductible mail Supply, coinsurance, and are generally sold on a group basis. An example of a Comprehensive Health policy is a major medical policy. Most major medical plans contain a lifetime maximum benefit that limits the insurer is total exposure under a contract, while few contain a / maximum benefit which limits the medical expenses covered for each cause.
surgical expense policies
commonly written in conjunction with Hospital expense policies. These policies pay for the cost of Surgeons Services, whether the surgery is performed in or out of the hospital. Coverage includes surgeons fees, and anesthesiologist, and the operating room.
Hospital expense policies
cover Hospital Room & Board, miscellaneous Hospital expenses, such as lab and x-ray charges common medicines use of operation room, and supplies. These expenses are covered while the insured is confined in a hospital. There is no deductible and the limits on room and board or set a specific dollar amount per day up to a maximum number of days. Hospital room and benefits cover expenses for occupancy of the room and bed, General Nursing Care, food and Beverages, and personal hygiene items. Note these limits may not provide for the full amount of Hospital Room & Board charges incurred by the insured. For example, if the hospital expense benefit was $200 per day in the hospital actually charged $400 per day, the insured would be responsible for the additional $200 per day
flexible savings accounts
flexible savings accounts sometimes called flexible spending accounts, tax-advantaged accounts that can be set up through a cafeteria plan of an employer the FSA allows an employee to set aside a portion of earnings to pay for qualified medical expenses such as prescription medicine, as established in the cafeteria plan
health savings accounts
health savings account is a tax advantaged medical savings account available to individuals who are enrolled in a high-deductible health plan. The funds contributed to an account are not subject to federal income tax at the time of deposit and roll over and accumulate Year to you if not Spence. H essays are owned by the individual and are an alternate tax-deductible source of funds used to pay for qualified medical expenses at any time without federal tax limit or penalty.
health savings accounts continued
health savings accounts are designed to help individuals save for qualified Health expenses they and their spouse or their dependents incorrect HSA contributions are tax-deductible. An individual who is covered by a high-deductible health plan can make a tax-deductible contribution to an HSA and use it to pay for out-of-pocket medical expenses. An individual must not be covered by other health insurance does not apply to, accidents insurance, disability, Dental Care, Vision Care, long-term care, must not be eligible for Medicare, and can't be claimed as a dependent on someone's tax. distributions other than for qualified medical expenses to a health savings account are taxable and subject to penalty of 20%
per cause deductible
in a per cause deductible, the insured must satisfy a deductible for each accident or illness.
all cause deductible
in an all cause deductible, the insured only has to meet the deductible amounts once during the benefit period.
position expensepolicies
often referred to as basic physician non surgical expense coverage because it provides coverage for non-surgical Services if physician provides. Basic medical expense coverage can be purchased to cover emergency accident benefits, maternity benefits, mental and nervous disorders, Hospice Care, Home Health Care, outpatient care, and nurses expenses. Regardless of what type of plan or coverage is purchased these policies usually offer only limited benefits that are subject to time limitations.
critical illness policies
pays a lump sum to the insured upon the diagnosis and survival of a critical illness. The insured must survive the illness for a certain period of time. The insurer may have a list of critical illnesses they will cover. Also known as specified disease plans
Hospital Indemnity policies
pays a specified amount on a daily, weekly or monthly basis to the insured while the insured is confined to a Hospital. Payment under this type of policy is unrelated to the medical expense incurred, but based only on the number of days confined in a hospital. Indemnity plans normally only make payments after receiving and reviewing the actual hospital bill. Any health provider may be used. Pay on a fee-for-service basis.
limited risk dread disease policies
provide a variety of benefits for a specific disease such as cancer or heart disease. Benefits are usually paid as a scheduled, fixed dollar amount for specific perils or medical procedures such as Hospital confinement or chemotherapy
stop loss
stop-loss provision is a feature designed to limit the amount of an insurance out-of-pocket medical expense. often, the stop-loss will state that after the insured is paid a specific amount toward his covered expense, the insurer will pay 100% of the remaining expenses. Will pay up to the maximum limit of the policy and for remainder of policy year.
limited benefit policies
there are a variety of health insurance policies providing limited coverage for specific accidents or sickness. These contracts must specify the type of accident or sickness covered, limited perils and amounts a coverage. Benefits may be paid on a reimbursement or Indemnity basis. specified disease Insurance can cover such things as out-of-pocket payments, non-covered medical expenses comment and initial costs.
approaches
there are three different types of approaches used by insurance and providing surgical expense coverage and determining the benefits payable. These are, Surgical schedule approach, the reasonable and customary approach, and the relative value scale approach.
supplementary Major Medical
these policies are used to supplement the coverage payable under a basic medical expense policy. After the basic policy pays, the supplemental major medical will provide coverage for expenses that are not covered by the basic policy, and expenses that exceed the maximum. If the time limitation is used up in the basic policy, the supplemental coverage will provide coverage thereafter.
carryover provision
this policy feature allows an insured to defer current house charges to the following Year's deductible instead of the current Year's deductible the major medical deductible carryover. Normally applies to expenses incurred during the last three months of the plan year.
approaches continued
under the surgical schedule approach, every surgical procedure is assigned a dollar amount by the insurer. Under the usual, customary, and reasonable approach, the surgical expense is compared to what it is deemed reasonable and customary for the geographical part of the country where the surgery is performed. The usual, customary and reasonable approach is the maximum amount an insurer will consider eligible for reimbursement under health insurance plan. The relative value approach is similar to the surgical schedule method. The difference is that instead of a flat dollar amount being assigned to every surgical procedure, a specified set of units is assigned. The policy will carry a stated dollar per units amount known as the conversion factor, to determine the benefit.
integrated deductible
used one in major medical plan is supplementing basic coverages. Example, if the major medical has $500 deductible and the insured has basic coverage of $500 or more, then, in the event of a claim, the amount paid by the basic coverage satisfies the major medical deductible. However, if the basic does not cover the entire deductible amount of the major plan, the insured is required to make up the difference.
Corridor deductible
when a major medical policy is supplementing basic coverage that contains no deductible, the corridor deductible is not applied until the basic coverage is exhausted.
