Medical Expense Insurance Rated 100% Correct!!

Medical expense insurance - provides benefits for medical care. Contracts may provide for payment of medical expenses incurred on a reimbursement basis (by paying benefits to the policyowner), payment on a service basis (by paying those who provide the services directly), or payment of an indemnity (by paying a set amount regardless of the amount charged for medical expenses). Medical expense or hospitalization insurance may be written on an individual or group basis. Benefits provided cover the individual and eligible dependents. Although there are many types of benefits available, medical expense insurance can generally be categorized as basic medical expense insurance, major medical insurance, comprehensive medical insurance, and special policies. Note that these products have largely been replaced by managed care alternatives and are no longer sold as stand-alone coverages. These types of plans have been modified and replaced in response to changes in the health care field relative to cost containment and market competition. However, an understanding of basic medical, hospital, and surgical plans can serve as a foundation for understanding the hybrid plans currently being marketed. Basic coverages provided by an individual medical expense policy include hospital expense, surgical expense, and medical expense. These three basic coverages may be sold together or separately. Frequently this is written as "first dollar" coverage, which means it does not have a deductible. Hospital Expense Benefits - provides benefits for expenses incurred during hospitalization. In some cases, surgical benefits may be included for certain types of surgery and associated costs. Hospital indemnities are usually classified into two broad groups: - Room and board, including nursing care and special diets; Miscellaneous medical expenses, including x-rays, laboratory fees, medications, medical supplies, and operating and treatment rooms Room and Board Benefit - Hospital expense coverage provides benefits for daily hospital room and board and miscellaneous hospital expenses (not including telephone and television) while the insured person is confined to the hospital. The policy may provide for a certain dollar amount for the daily hospital room and board benefit, although the trend is toward coverage of not more than the semiprivate room rate unless a private room is medically necessary. The room and board benefit may be paid on either an indemnity basis or a reimbursement basis, depending on the particular policy. When room and board are covered on an indemnity basis, the insurer pays a specified, preestablished amount per day, as shown in a schedule in the policy, for a stated maximum number of days. Indemnity policies are sometimes called dollar amount plans. Room and board rates vary by geographic location, but it is not unusual to find room and board rates ranging from $300 to $500 per day or more. Typically, the maximum number of days is from 90 to 365. More commonly, room and board expenses are paid on a reimbursement basis. This is also referred to as an expenses-incurred basis. Some room and board benefits include intensive care, which may be paid in full or in part. Hospital plans with this provisiongenerally provide for a maximum intensive care benefit of some multiple of the room and board maximum—usually two or three times. For example, if the room and board maximum is $400 per day, the plan might pay twice that amount, or $800 per day, for intensive care. A limit might also be placed on the number of days for which this benefit will be paid. Under a reimbursement arrangement, the policy will pay in one of two ways. - 1) The actual charges for a semiprivate room are covered. 2) A percentage of the actual charges is paid, with no specific dollar limit. Under the first reimbursement option—actual charges—the insurer will pay the full actual semiprivate room rate, regardless of what it is, as indicated in the illustration that follows. Under this same arrangement, however, the insurer still pays only the semiprivate room rate if the insured must be in a private room, as indicated in the following chart. Under the second reimbursement option—payment of a percentage of the actual charges—the insurance company pays a specified percentage, regardless of what the actual charges are. A common percentage is 80%.