Health Insurance Quotes !

     Specializing in Michigan and Ohio but available in all 50 states

   Individual Health Insurance                          Temporary Health Insurance
      Group Health Insurance                                   Dental Insurance

     What are the principal types of medical expense insurance coverage?

Medical expense insurance is broadly classified into two principal types of coverage: base (or basic) plans and major medical plans. Base plans generally consist of either hospital expense coverage, surgical expense coverage, or both. Basic hospital and surgical expense plans generally provide coverage on a first-dollar basis (i.e., no deductible) and provide 100 percent reimbursement of covered expenses, up to a relatively low maximum of $10,000, $25,000, $50,000 or $100,000. Major medical plans, in contrast, apply a deductible to initial expenses, generally ranging from $100 to $500 per calendar year. After the deductible is satisfied, major medical plans typically reimburse 80 percent of eligible expenses up to a relatively high maximum, e.g., $500,000 or $1,000,000. Some major medical plans reimburse eligible expenses at 70 percent; some plans also provide unlimited lifetime benefits. Major medical plans typically cover a broad list of medical expenditures, including hospital expense, surgical expense, physician (non-surgical) expense, private duty nursing, diagnostic X-ray and laboratory services, prescription drug expense, artificial limbs and organs, ambulance services, and many other types of medical expenses when prescribed by a duly licensed physician. Thus, in comparison with basic plans, major medical plans provide much broader coverage, with higher limits, but these plans require the insured to share in the cost of medical care through deductibles and coinsurance (i.e., 20 or 30 percent of eligible expenses above a deductible amount).

Is medical expense coverage available for substance abuse and mental illness?

Major medical expense plans also generally provide coverage for treatment of substance abuse (e.g., alcoholism and drug usage) and mental illness. A higher coinsurance percentage (e.g., 50 percent) and a lower lifetime benefit limit (e.g., $25,000 or $50,000) generally applies, however. In addition, the extent of coverage may depend on whether treatment is provided on an in-patient or out-patient basis.

What types of expenditures are commonly excluded under major medical expense plans?

Although providing very broad coverage, major medical plans typically contain a number of exclusions. Common exclusions include medical expenditures arising from: (1) convalescent or custodial care; (2) physical examinations, unless required for the treatment of an injury or illness (it should be noted that some plans now cover this expenditure); (3) cosmetic surgery unless required to correct a condition resulting from an injury or a birth defect; (4) occupational injuries and illnesses that are otherwise covered under a Workers' Compensation law; and (5) routine dental and vision care (care required for treatment of an injury and dental and eye surgery are frequently covered, however). Other common exclusions relate to benefits provided by government agencies (e.g., VA hospitals) and expenses paid under other insurance programs, including Medicare.

Even though major medical plans provide broad coverage, insureds still incur certain "out-of-pocket" costs. What are these costs?

An insured's "out-of-pocket" costs under major medical expense plans include the deductible, cost-sharing amounts arising from the operation of the coinsurance clause, and medical expenditures that are deemed by the plan to be in excess of "reasonable and customary" charges. Only charges that are "reasonable and customary" for a specific type of service, in a particular location or geographic area, are eligible for reimbursement under medical expense plans. The definition of "reasonable and customary" may vary somewhat from one medical expense plan to another.

What is the coinsurance clause in medical expense plans and how does it work?

Coinsurance, sometimes called "percentage participation," requires the insured to share in the cost of medical care. Under an 80/20 coinsurance provision, the medical expense plan pays 80 percent of eligible medical charges above any deductible. The insured is required to pay the remaining 20 percent. Other coinsurance arrangements, e.g., 70/30 or 90/10, are sometimes used. In the event of large or catastrophic medical expenses, an insured might suffer severe financial hardship due to the operation of the coinsurance clause. To compensate for this possibility, many major medical expense plans contain a coinsurance cap, or stop-loss limit. This provision places a limit on the insured's out-of-pocket costs in a given year arising from the operation of the coinsurance clause. The size of the coinsurance cap generally ranges from $2,000 to $3,000, depending on the plan, although limits as low as $1,000 are sometimes used. Once the coinsurance cap has been reached, all eligible expenses above this amount are paid in full, up to the plan's overall limit of coverage.

What is the difference between coinsurance and copayment?

On occasion, these terms have been used interchangeably. However, it is preferable to define the two terms differently, despite their similarity of purpose. Under a copayment or copay provision, the insured usually is required to pay a set or fixed dollar amount (e.g., $3, $5, or $10) each time a particular medical service is used. Copay provisions are frequently found in medical plans offered by health maintenance organizations (HMOs) where a nominal copayment is applied to each office visit and to each prescription that is filled.

What is a preexisting conditions clause and what is the effect of its inclusion in major medical expense plans?

A preexisting condition is often defined as a medical condition (i.e., an injury or illness) that required treatment during a prescribed period of time, e.g., 3 or 6 months, prior to the insured's effective date of coverage under the major medical expense plan. Sometimes, a preexisting condition is defined to include medical conditions that were known to the insured, even though no treatment was provided during the prescribed period. A preexisting conditions clause excludes coverage for preexisting conditions for possibly as long as 12 months after the effective date of coverage. Because the definition of a preexisting condition, and the provisions of the clause itself, may differ considerably from one plan to another, it is recommended that newly insured individuals (and prospective insureds) completely familiarize themselves with this policy provision.

How does the medical expense coverage offered by Health Maintenance Organizations (HMOs) differ from the coverage provided under basic and major medical expense plans?

Basic and major medical expense plans are generally classified as indemnity contracts. These plans indemnify, or reimburse, the insured for medical expenses incurred and typically require the completion and filing of claim forms. In addition, these plans usually contain deductible and coinsurance cost sharing provisions and may restrict coverage for certain types of medical care expenditures. Indemnity plans, however, provide the insured with substantial freedom relative to the choice of physician, including whether a primary care physician or a specialist will be seen. In contrast, HMO coverage emphasizes comprehensive (including preventive) care and typically contains very few exclusions, no (or small) deductibles, and nominal copayments. However, there is much less freedom of choice of physician under traditional HMO coverage since the patient is typically required to be under the care of a primary care physician who serves as a "gatekeeper." In this role the primary care physician determines whether the services of a specialist are needed, in addition to determining what other medical services are required for treatment. Some HMOs today offer a point-of-service option, whereby patients may opt for indemnity type coverage (with a deductible and coinsurance) when they desire medical treatment outside the HMO network.

                                          1-800-510-4474    

               Get your Free Health Insurance Quote!

This site is professionally hosted by JRAComputer Repair and Web Hosting for only $9.00 per month  on business class servers with great service and customer support.

                                                                                                                           nsurance  medical insurance michigan  affordable  low cost  michigan  health  insurance  medical  Michigan Health Insurance  medical  BCBS Michigan  hap  ppo   ppom   company  plan  low cost  ndividual  self employed  company  in  quote  individual  jra computer michigan health insurance   the quality michigan health insurance people serving all of michigan and ohio   michigan health care   health care michigan  michigan medical insurance   medical insurance michigan   affordable  medical  low cost  health insurance price quotes  michigan  ohio  free online quote  quote  michigan  ohio  Indiana Health Insurance  Medical Insurance  Health Insurance  Medical Insurance  company  plan  low cost  ndividual  self employed  company  in  quote  individual  COBRA  PPOM  NASE  ppo  Mega Life  Blue Cross Blue Shield Michigan   BCBS Michigan  HAP  Golden Rule  Fortis  Short Term Medical  Student Medical  medical coverage  michigan health care  health care michigan  michigan medical insurance  medical insurance michigan  affordable  low cost  michigan  health  insurance  medical  Michigan Health Insurance jra computer michigan health insurance   the quality michigan health insurance people sqw er  rt  ty  a d jserving all of michigan aqw er  rt  ty  a d js nd ohio   michigan health care   health care michigan  michigan medical insurance   medical insurance michigan  affordable  low cost  health insurance price quotes  michigan   ohio  free online quote  quote  michigan  ohio  Indiana Health Insurance  Medical Insurance  Health Insurance  medical  Medical Insurance  company  plan  low cost  ndividual  self employed  company  in  quote  individual  COBRA  PPOM  NASE  ppo  Mega Life  Blue  Cross Blue Shield Michigan  BCBS Michigan  HAP  Golden Rule  Fortis  Short Term Medical  Student Medical  medical coverage  michigan health care  health care michigan  michigan medical insurance  medical insurance michigan  affordable  low cost  michigan  health  insurance  medical  Michigan Health Insurance  jra  computermichigan health insurance   the quality michigan health insurance people serving all of michigan ohio   michigan health care   health care michigan  michigan medical insurance   medical insurance michigan  affordable  low cost  health insurance price quotes  michigan   ohio  free online quote   quote   michigan  ohio  Indiana Health Insurance  Medical Insurance  Health Insurance  Medical Insurance  medical  company  plan  low cost  ndividual  self employed   company   in  quote  individual  COBRA   PPOM  NASE  ppo  Mega Life  Blue Cross Blue Shield Michigan  BCBS Michigan   HAP   Golden Rule  Fortis  Short Term  Medical  Student Medical  medical coverage  michigan health care  health care michigan  michigan medical insurance  medical insurance michigan  affordable  low cost  michigan  health  insurance  medical  Michigan Health Insurance  jra computer!michigan health insurance   the quality michigan health insurance people serving all of michigan and ohio  michigan health care  health care michigan  michigan medical insurance  medical insurance michigan  affordable  low cost  health insurance price quotes  michigan  ohio  free online quote   quote   michigan   ohio   Indiana Health Insurance  Medical Insurance  Health Insurance  medical  Medical  Insurance  company  plan  low cost  ndividual  self employed  company  in  quote  individual  COBRA  PPOM  NASE  ppo  Mega Life  Blue Cross Blue Shield Michigan  BCBS Michigan  HAP  Golden Rule  Fortis  Short Term Medical  Student Medical  medical coverage  michigan health care  health care michigan  michigan  medical insurance  medical insurance michigan  affordable  low cost  michigan  health  insurance  medical  Michigan Health Insurance  jra computermichigan health insurance   the quality michigan health insurance people serving all of michigan and ohio   michigan health care   health care michigan  michigan medical insurance   medical insurance michigan  affordable  low cost  health insurance price quotes  michigan   ohio  free online quote  quote  michigan  ohio  Indiana Health Insurance  Medical  Insurance  Health Insurance  Medical Insurance  medical  company  plan  low cost  ndividual  self  employed  company  in  quote  individual  COBRA  PPOM  NASE  ppo  Mega Life  Blue Cross Blue Shield Michigan  BCBS Michigan  HAP  Golden Rule  Fortis  Short  Term Medical  Student Medical  medical coverage  michigan health care  health care michigan  michigan medical insurance  medical insurance michigan  affordable  low  cost  michigan  health  insurance  medical  Michigan Health Insurance  jra computer"michigan health insurance   the quality michigan health insurance people serving all of  michigan and ohio   michigan health care   health care michigan  michigan medical insurance   medical insurance michigan  affordable  low cost  health insurance price  quotes  michigan   ohio  free online quote   quote   michigan  ohio  Indiana Health Insurance  Medical Insurance  Health Insurance  Medical Insurance  company  plan  low  cost  ndividual  self employed  company  in  quote  individual  COBRA  PPOM  NASE  Mega Life  Blue Cross Blue Shield Michigan  BCBS Michigan   HAP  ppo   Golden  Rule  Fortis  Short Term Medical  medical  Student Medical  medical coverage  michigan health care  health care michigan  michigan medical insurance  medical insurance  michigan  affordable  low cost  michigan  health  insurance  medical  Michigan Health Insurance  jra computer michigan health insurance quality michigan health insurance  people serving all of michigan and ohio  michigan health care  health care michigan  michigan medical insurance medical insurance michigan affordable low cost health  insurance price quotes michigan ohio free online quote  quote  michigan  ohio  Indiana Health Insurance  Medical Insurance  Health Insurance Medical Insurance  medical company plan low cost individual  self employed company quote  individual  COBRA  PPOM  NASE ppo Mega