|
SolveYourProblem
eLearning Series:
Health Insurance: Your Questions Answered
What does everything mean & how
to choose the right policy
( 18 pages )
MEDICAL
EXPENSE BENEFITS
Other
medical expense benefits fall into a category in addition
to the hospital, surgical and medical benefits previously
discussed. These optional benefits vary from insurer
to insurer and may or may not include as part of their standard
policies. Separate policies can sometimes be written to
include these benefits. Some of them are:
- Maternity
- Convalescent
– Nursing home
- Emergency first-aid
- Home health
care
- Mental infirmity
- Hospice care
- Prescription
drugs
- Dread disease
- Outpatient
treatment
- Dental
- Private duty
nursing
- Vision
We will not cover
all of these options, but will let’s take a look at the most
common.
Maternity
benefits are sometimes included in policies subject
to certain conditions and limitations. The most usual limitation
is a 10 month waiting period designed to prevent the purchase
of health insurance just to cover pregnancy and childbirth
expenses. Interesting to note, however, group policies
for employee groups of 15 or more are required by law to
provide maternity benefits on the same basis as non-maternity
benefits. This means that in a case such as this, the waiting
period would not apply unless non-maternity benefits also
required a 10 month waiting period.
Aside from the
group scenario above, many policies just exclude maternity
benefits totally but make them available at extra cost. Where
maternity benefits do apply, the benefit usually includes
newborn care while the mother is in the hospital.
Other benefits
that are sometimes available under the same maternity coverage
might include cesarean deliveries, natural abortions and
elective abortions.
Emergency
First Aid Coverage applies to an accident that
may call for immediate first-aid on the scene. This applies
when a medical professional who just happens on the scene
provides first-aid service he/she might bill the insured.
Sometimes treatment like this must be performed without
the knowledge or assent of the insured. Some policies offer
coverage for such contingencies and normally must incur
within a very short time after an accident.
Mental
Infirmity historically has been excluded from
most policies. However, in recent years more and more policies include
this type of coverage but with limitations. The benefits
are usually much lower than physical ailments and a stated percentage
of the benefit paid for other types of medical care is
included.
Common
exclusions and limitations. Both disability income
and medical expense policies limit or exclude coverage for
certain types of injuries or illness. There is a difference
between limitations and exclusions. The mental infirmity
policy limitations we discussed above is an example, whereas
an exclusion is completely omitted from any coverage.
It is important
that you deal with a knowledgeable agent because state laws
and policies may differ on specific items. Some items that fall
into the common exclusions and limitations might be:
- Pre-existing
conditions as defined by your policy and dictated by state law.
- Hernia however
the growing trend is to cover the condition.
- Self-inflicted
injuries
- Suicide
- War and/or
acts of ware that result in injury or death
- Military duty
- Non-commercial
air travel
- Injury while
committing a felony
- Injury, illness
or death incurred while under the influence of alcohol or
narcotics
- Cosmetic surgery
unless for surgery required as a result of an accidental
injury or a congenital defect
- Dental expense,
unless resulting from accidental injury
- Vision correction
such as eye exams, eyeglasses and contact lenses
- Care provided
by governmental facility which is normally covered by the
Veterans Administration or by workers compensation
- Sexually transmitted
diseases
- Experimental
procedures
- Organ transplant
- Infertility
treatment and services
- Alcohol and
drug abuse treatment
Up to this point
we have discussed “basic” benefits that are designed to cover
some hospital, medical and surgical costs that are primarily
considered to be minor. When purchased individually, these
benefits can be substantially less than actual costs incurred.
 
> Home > Health
Insurance Main Page
|
