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Share your insurance ideas and expertise. Respond to questions and comments Joslyn [2010-03-09] ... I'm choosing health insurance for the first time. What is the difference between a HMO and a PPO? Reply

Individual Insurance

Personal health coverage offers reimbursement for health care. Prescription assistance programs are included in some policies. Certain plans might provide for payment of medical charges 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 fixed sum regardless of the sum charged for health expenses. Health expense or hospitalization insurance can be written on an individual or group basis. Many of these policies will provide prescription help.

While there are countless types of benefits to be had, personal health expense coverage will generally be categorized as basic health expense coverage, major medical coverage, comprehensive medical coverage, and special policies. These Programs ought to cover prescriptions because prescription drugs help so many people. The majority of these policies have for the most part been replaced by managed care options and are no longer available as stand-alone plans. These types of policies 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 individual medical expense policy includes hospital expense, surgical expense and medical expense. These three basics could be issued together or separately. Normally this is issued as “first dollar” coverage, which means it does not contain a deductible.

As the name indicates, hospital expense health insurance offers benefits for expenses incurred for the period of hospitalization. Hospital indemnities are customarily classified into two broad groups:

  • Room and board, together with nursing care and special diets
  • Miscellaneous medical expenses, including x-rays, laboratory fees, prescriptions, medical supplies, and operating and treatment rooms

In certain cases, surgical benefits may be built-in for a variety of types of surgery and related expenses. Hospital expense healthcare insurance offers benefits for daily hospital room and board and miscellaneous hospital bills whilst the insured person is confined to the hospital. The plan can provide for a specified dollar amount for the daily hospital room and board benefit, though the tendency is in the direction of health insurance of not more than the semiprivate room rate unless a private room is medically needed. The room and board benefit might be paid on either an indemnity basis or a reimbursement basis, depending on the specific policy.

Indemnity programs are every so often called dollar amount policies. Room and board rates change by geographic location, however it is not abnormal to notice room and board rates ranging from $200 to $650 per day or more.

Usually, the maximum number of days is from 40 to 450 . More frequently, room and board expenses are paid on a reimbursement basis. This is {frequently referred to as an expenses-incurred basis~This is commonly called a expenses incurred basis~This is often times called a expenses incurred basis}. Under this deal, the health insurance will reimburse in one of two methods.

• The actual bills for a semiprivate room are covered.

• A percentage of the actual fee 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 medical insurance company pays a specific percentage, regardless of what the actual charges are. A universal percentage is 80%.

To sum up, under the actual charges style of reimbursement plan, the health insurance will pay the actual amount billed for a semiprivate room without regard to a specific dollar limit. Under the percentage type of reimbursement policy, the plan might pay a certain percentage of the actual charges.

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RECENT COMMENTS

Joslyn
2010-03-09
I'm choosing health insurance for the first time. What is the difference between a HMO and a PPO? insure
Kat
2010-03-08
BCBS PPO coverage for weight loss surgery? I have recently been considering having the lap band done. I am wondering would BCBS PPO cover for it. I am a dependent on this insurance and I am 21. I am covered until I am 25. I have heard it depends on what policy the employer agrees upon but I am not sure what kind of policy my parents have. Does anyone know what kind of policy WLS would be covered under. And if not covered all the way would it be covered any? I am a little apprehensive about doing all this but I need to find out if I am even covered at all and I'm not quite sure how to go about finding out how. insure
Jeff Callison
2010-03-04
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