Even though there are various types of benefits offered, personal medical expense insurance will by and large be categorized as basic medical expense insurance, major medical insurance, comprehensive medical coverage, and special plans. These plans ought to cover prescriptions because prescription drugs help so many people. Most of these programs have essentially been replaced by managed care plans and are no longer available as stand-alone plans. These types of policies have been adapted and replaced in response to changes in the health care field relative to cost control and market competition.
Basic health insurance provided by a individual health expense plan includes hospital expense, surgical expense and medical expense. These three basics may be written together or individually. Normally this is written as “first dollar” coverage, which means it does not have a deductible.
As the name indicates, hospital expense healthcare insurance offers benefits for expenses incurred throughout hospitalization. Hospital indemnities are by and large classified into two general categories:
• Room and board, including nursing care and special diets
• Miscellaneous health charges, as well as x-rays, laboratory fees, medications, medical supplies, and operating and treatment rooms
In several cases, surgical benefits may be incorporated for some types of surgery and associated costs. Hospital expense healthcare insurance provides benefits for daily hospital room and board and assorted hospital bills while the insured patient is confined to the hospital. The plan may well provide for a specified dollar amount for the daily hospital room and board benefit, though the trend is in the direction of medical insurance of not more than the semiprivate room rate unless a private room is medically required. The room and board benefit could be paid on either an indemnity basis or a reimbursement basis, depending on the particular policy.
Indemnity plans are on occasion called dollar amount policies. Room and board rates differ by geographic location, but it is not abnormal to discover room and board rates ranging from $300 to $900 per day or more.
In general, the maximum number of days is from 50 to 20 . More commonly, room and board charges are paid on a reimbursement basis. This is frequently called a expenses incurred basis. Under this arrangement, the plan will pay in one of two methods.
• The actual bills for a semiprivate room are covered.
• A percentage of the actual cost is paid, with no explicit dollar limit.
Under the first reimbursement option, the health insurance company will pay the full actual semiprivate room rate, regardless of what it is. Under the second reimbursement option, the insurance company pays a specific percentage, regardless of what the actual charges are. A frequent percentage is 80%.
To summarize, with the actual charges kind of reimbursement program, the plan will pay the actual amount billed for a semiprivate room without regard to a specific dollar limit. With the percentage style of reimbursement health insurance, the program may pay a certain percentage of the actual charges.
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