Major medical insurance is healthcare coverage that encompasses
a broad range of medical expenses. Some healthcare plans have
holes in their coverage with huge limitations on the treatments
or conditions they cover. With major medical insurance you
will generally have higher individual and family limitation
amounts and will be covered both inside and outside of the
hospital. There are basically two types of major medical health
insurance; comprehensive major medical insurance and supplemental
major medical insurance.
Comprehensive Major Medical Health InsuranceThis type of major medical insurance is the more traditional where all types of covered expenses are rolled into one policy. With comprehensive there are two ways a policy can be handled. Some policies are based on first dollar coverage, which means that the moment healthcare expenses are acquired the insurance carrier will begin paying benefits. The other policies are not based on first dollar coverage and will require a deductible amount to be paid before coverage begins or before benefits are paid.
Also, depending upon the policy obtained, sometimes comprehensive
major medical health insurance has a coinsurance policy, meaning
that any amount incurred after the deductible is paid is shared
between the insurance company and the policy holder. You may
have heard of this before as an 80/20 policy, where the insurance
company will cover 80% of incurred expenses and you, as the
policy holder, are responsible for the remaining 20%. For
example, if a patient obtains $1,100 in medical expenses and
his deductible is $100, he would first pay the $100 to cover
the deductible amount. This would leave $1,000 to be split
between the insurance carrier and the patient. Therefore,
$800 would be paid by the insurance company and $200 would
be the patient's responsibility.
With a coinsurance plan, most carriers will implement a maximum
patient out-of-pocket limit. This means that if the patient’s
maximum is $3,000, then once that amount has been paid by
the patient (between deductible and 20% responsibility) the
insurance carrier will cover the remaining amount of expenses
during the coverage period.
Supplemental Major Medical Health Insurance
A supplemental major medical health insurance plan is typically used as a back-up to other coverage. This often will help to pay the patient responsibility amounts of other coverage plans. As the name suggests, this type of insurance is used to supplement other insurance policies and not to be the main source of health insurance coverage. Most often this type of insurance in used in cases of surgical procedures and hospital stays, but can be used in conjunction with any covered medical procedure, treatment or visit.Supplemental major medical insurance also usually requires a deductible to be paid before coverage payments begin and in line these policies have a maximum out-of-patient limit. Decide what works best for you and your family and once you understand the types of coverage available to you, you will be able to best make the decision on how to provide medical coverage for you and your family. |
