Medical Expense InsuranceBasic Insurance Questions Answered
Health expense insurance policies allow people to transfer future unforeseen medical expense risk to an insurance company.
An agent may focus on any one of these types of policies or work as a generalist who provides many different products to an individual customer.Payment of Benefits
Benefits may be paid directly to the insured on a reimbursement basis, or the insured may assign benefits to be paid directly to the health care provider.Basic Hospital, Medical, & Surgical Insurance
Basic medical insurance consists of mono-line coverages, which means it covers only one type of medical expense. It was the primary form of medical insurance sold for many years. Coverage is limited and set low (such as $10,000) for any given situation. When benefits are paid according to the amount listed on the schedule, the plan is called a scheduled plan. While there is usually no deductible or co-insurance amount, the basic/scheduled amount is generally less than the usual and customary charge for that service in that area and the patient has to pay the difference themselves. The maximum dollar amount and the schedule are determined by the policy.
Examples of Basic Medical Insurance are:
- Basic Hospital Expense: Reimburses the insured for the cost of daily room and board and other miscellaneous expenses while hospitalized. Benefit periods can be as short as 30 days or as long as 365 days.
- Basic Surgical Expense: Pays the cost of surgeon services whether in or out of the hospital. Other professional fees associated with the surgery, such as an anesthesiologist, are generally also included. Benefits are usually paid on a Relative Value Schedule, in which a particular type of surgery is assigned a value that is then multiplied by the dollar unit value to determine the amount the policy will pay for that procedure.
- Basic Medical (Physician) Expense: Covers non-surgical physician and other medical expenses such as a doctor s hospital visit(s). Non-doctor expenses such as xrays or drugs are generally excluded.
Individuals interested in offering medical insurance coverage should consider looking into one of our many Health Insurance Licensing courses.