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medical expense insurance (vocab (critical illness policies (pays a lump…
medical expense insurance
typically excludes coverage for care provided in a government facility
provides protection against cost of medical care for illnesses and accidents
broadness of what is covered is dependent on the specific policy written
sometimes called first dollar insurance b/c you don't pay a deductible
typically has lower benefit limits than major medical insurance
benefits provided by it are lower than the actual expenses incurred
hospital expense policies
cover expenses from what is charged from the hospital. although not necessarily in full. your benefit may be 200 and the bill might be 400.
surgical expense policies
many times it goes with hospital expense policies
cover costs of surgery, whether in or out of hospital
approaches
surgical schedule approach
every surgical procedure is assigned a dollar amount by the insurer
usual, customary, and reasonable approach (ucr)
surgical expense is compared to what is reasonable and customary for that area
maximum amount an insurer will consider eligible for reimbursement under a health insurance plan
relative value approach
like schedule approach except units are assigned to procedures instead of flat dollar amounts
policy has a dollar per units amount called a conversion factor that is used to calculate the benefit received
physician expense policies
often referred to as basic physician nonsurgical expense coverage
offer limited benefits that are subject to time limitations
can cover emergency accident/maternal/hospice care/home health care/outpatient care/nurses expenses/nervous disorders -- a lot of different things
major medical expense plans
offer broad coverage under one policy
vocab
stop loss is when you've paid up total deductable
supplemental policy covers co-insurance
dread disease/limited risk covers a specific disease like cancer or heart disease
critical illness policies
pays a lump sum upon diagnosis of and survival of a critical illness
must survive 30 days
insurer will have list of critical illnesses
aka specified disease plans
hsa pays copays, deductibles