Individual medical coverage offers benefits for health care. Prescription assistance programs can be included in some programs. Certain policies may possibly provide for payment of medical expenses incurred on a reimbursement basis by paying benefits to the plan owner, payment on a service basis by paying those who provide the services directly, or payment of an indemnity by paying a prearranged sum regardless of the amount charged for medical expenses. Medical expense or hospitalization insurance could be issued on an individual or group basis. Some of these programs will provide prescription help.
Even though there are numerous types of benefits offered, private medical expense insurance can normally be categorized as basic medical expense coverage, major medical coverage, comprehensive medical coverage, and special policies. These Programs ought to cover prescriptions because prescription drugs help so many patients. Nearly all of these plans have for the most part been replaced by managed care policies and are no longer offered as stand-alone plans. These types of plans have been adapted and replaced in answer to changes in the health care field relative to cost control and market competition.
Basic medical insurance provided by a private medical expense plan includes hospital expense, surgical expense and medical expense. These three basics may be sold as one or separately. Often this is issued as “first dollar” coverage, which means it does not have a deductible.
Like the name implies, hospital expense coverage offers benefits for visits incurred for the period of hospitalization. Hospital indemnities are as a rule classified into two general groups:
• Room and board, with nursing care and special diets
• Miscellaneous medical charges, plus x-rays, laboratory fees, prescription drugs, medical supplies, and operating and treatment rooms
In several cases, surgical benefits possibly will be included for certain types of surgery and related costs. Hospital expense coverage provides benefits for daily hospital room and board and miscellaneous hospital charges while the insured patient is confined to the hospital. The plan could provide for a guaranteed dollar amount for the daily hospital room and board benefit, although the trend is in the direction of health insurance of not more than the semiprivate room charge unless a private room is medically required. The room and board benefit may possibly be paid on either an indemnity basis or a reimbursement basis, depending on the specific policy.
Indemnity programs are every now and then called dollar amount plans. Room and board rates change by geographic location, but it is not unusual to find room and board rates ranging from $250 to $600 per day or more.
More often than not, the maximum number of days is from 90 to 500 . More frequently, room and board expenses are paid on a reimbursement basis. This is {frequently called an expenses incurred basis~This is also known as a expenses incurred basis~This is commonly called a expenses incurred basis}. Under this agreement, the health insurance will pay in one of two ways.
• The actual expenses for a semiprivate room are covered.
• A percentage of the actual expense is paid, with no explicit dollar limit.
Under the first reimbursement option, the medical insurance carrier will pay the full actual semiprivate room rate, regardless of what it is. Under the second reimbursement option, the health insurance carrier pays a specified percentage, regardless of what the actual charges are. A normal percentage is 80%.
To recap, with the actual expenses form of reimbursement policy, the health insurance will pay the actual amount charged for a semiprivate room without regard to a specific dollar limit. With the percentage type of reimbursement insurance, the plan might pay a specified percentage of the actual charges.
