Individual Health Insurance Plans FAQ
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Most major medical plans require a deductible be paid before they pay out. Additionally, after the deductible has been met, you can guess coverage to be in this area 80% of the total medical expense incurred. Another feature of major medical plans is that they tend to have high maximum limits- from in this area 0,000 to Million. Moreover, major medical plans usually cover a wide array of medical costs including prosthetic limbs, x-ray/lab services and prescription drugs, for example. Simple To Insure ME has the answers
Consequently, while major medical plans often offer a wider array of coverage and high maximum limits, they require the insured to share in the costs. On the other hand, basic plans have lower cut off limits, but initiate immediately to cover 100% of the costs. What is looked-for here is careful consideration- it’s vital for you to weigh both options very carefully before choosing the individual health insurance that works best for you.
Are there expenses which are not included in major medical plans?
In small, yes. There are a digit of expenses generally excluded from major medical plans. Some include (but are not limited to): elective cosmetic surgery, custodial/convalescent care, injuries or illnesses already covered by workman’s compensation, routine vision and/or dental examinations and annual/routine physical examinations. Read your policy carefully, as all plans vary in what they exclude or include in coverage.
Are substance abuse and mental illness covered by health insurance?
Yes. Treatment for both substance abuse and mental illness are generally covered by major medical plans. Though, the insurer may require a higher co-insurance and may reduce the benefits of the policy overall. Additionally, the amount of coverage often depends on the location of the treatment- that is whether it is done on an outpatient or inpatient basis.
What do policies mean by “co-payment”?
A co-payment (sometimes called a co-pay) is a previously specified amount to be paid by the insured at the time they use services. Co-pays are generally establish in HMOs which often require co-pays for prescriptions and/or office visits for amounts ranging from to .
Please define “co-insurance” and clarify how it works.
Co-insurance is often called Percentage Participation and requires the participants to pay for a previously-agreed-upon percentage of the services rendered. For example, if your
