Archive for: November 2009

Private medical insurance offers benefits for medical care. Prescription assistance programs are included in some policies. Some plans can provide for payment of medical charges incurred on a reimbursement basis by paying benefits to the policy owner, payment on a service basis by paying those who supply the services directly, or payment of an indemnity by paying a set amount regardless of the amount charged for health bills. Health expense or hospitalization coverage may perhaps be written on an individual or group basis. Alot of these programs will provide prescription help.

Although there are a lot of types of benefits available, individual health expense coverage might generally be categorized as basic health expense coverage, major medical coverage, comprehensive medical coverage, and special programs. These Programs should cover prescriptions because prescription drugs help so many people. A good number of these programs have mostly been replaced by managed care policies and are no longer available as stand-alone programs. 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.

Basic health insurance provided by a private medical expense policy includes hospital expense, surgical expense and medical expense. These three basics may be sold as one or individually. Often this is written as “first dollar” insurance, which means it does not possess a deductible.

Like the name indicates, hospital expense insurance offers benefits for charges incurred throughout hospitalization. Hospital indemnities are mostly classified into two broad categories:

• Room and board, plus nursing care and special diets

• Miscellaneous medical expenses, including x-rays, laboratory fees, prescription drugs, medical supplies, and operating and treatment rooms

In certain cases, surgical benefits possibly will be included for selected types of surgery and associated costs. Hospital expense coverage provides benefits for daily hospital room and board and various hospital bills while the insured individual is confined to the hospital. The plan can provide for a certain dollar amount for the daily hospital room and board benefit, even though the movement is in the direction of medical insurance of not more than the semiprivate room charge unless a private room is medically needed. The room and board benefit can be paid on either an indemnity basis or a reimbursement basis, depending on the individual policy.

Indemnity plans are on occasion called dollar amount policies. Room and board rates differ by geographic location, however it is not abnormal to find room and board rates ranging from $400  to $750  per day or more.

Usually, the maximum number of days is from 40  to 400 . More commonly, room and board expenses are paid on a reimbursement basis. also referred to as an expenses-incurred basis~This is commonly called a expenses incurred basis~This is frequently called a expenses incurred basis}. Under this plan, the health insurance will pay in one of two ways.

• The actual bills for a semiprivate room are covered.

• A percentage of the actual expense is paid, with no specific dollar limit.

Under the first reimbursement option, the healthcare 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 specific percentage, regardless of what the actual charges are. A usual percentage is 80%.

To recap, with the actual expenses type of reimbursement program, the insurance will pay the actual amount billed for a semiprivate room without regard to a specific dollar limit. With the percentage type of reimbursement insurance, the program will pay a certain percentage of the actual charges.