Major medical insurance is extensive health insurance and is typically divided into two types, comprehensive and supplemental. Generally, major medical insurance covers a far more extensive range of services and procedures including those performed within as well as outside a hospital.
Comprehensive Major Medical Insurance
Comprehensive coverage applies to anything a traditional healthcare insurance policy covers while extending also to any other medical expenses one might incur.
Many comprehensive major medical insurance policies have a deductible, which is essentially met once you can demonstrate to your insurer that you’ve met your obligation through some type of covered expense. Other plans might have first dollar coverage which means the plan starts paying out as soon as any medical expense occurs, essentially carrying a zero deductible.
Major medical insurance might also have a co-insurance policy. Co-insurance works by sharing a medical expense through a specified percentage. For example, if you have a co-insurance of 80/20 that means that once you meet your deductible, beyond that you are responsible for 20% of the expense while the insurance company will pay for 80%.
Sometimes major medical insurance will stipulate certain conditions where the deductible is waived for up to a certain dollar amount. Say you have to have a surgical procedure done. Sometimes certain plans might pay the first several thousand dollars. After that, you are responsible for fulfilling your deductible and thereafter your regular co-insurance would take effect.
Supplemental Major Medical Insurance
A supplemental policy covers expenses beyond the scope of a basic health insurance policy. Generally, how a supplemental major medical insurance policy works is, you reach your maximum coverage with your basic plan, you then pay a deductible (often called a corridor deductible) and the supplemental plan takes effect. The supplemental policy then acts the same as a comprehensive policy and may include the same features such as co-insurance and an out-of-pocket maximum.
Most major medical insurance policies have a stop-loss or out-of-pocket limit. This stipulates that the insurer is no longer responsible for paying their medical expenses once a certain maximum amount has been reached. Thereafter the insurance company pays for anything and everything beyond that. Out-of-pocket maximums vary between different policies and may range from $100,000 to $2-million.
Benefits period in major medical insurance is the time during which benefits are paid. This might start on the first day of the illness or injury; or it might begin after your deductible has been satisfied. A benefits period might extend thereafter for up to two years or it can extend until the policy’s renewal date, where after it will reset. In either event, after the benefits period is over, a new deductible begins.
Internal limits are restrictions placed upon the major medical insurance wherein the policy will only pay for and up to a specified amount on various medical services and procedures. For instance, it might limit a hospital stay to a certain number of days or how many x-rays you can have per claim.
There several types of deductibles you may encounter in major medical insurance policies. A per-cause deductible is where you pay a deductible for each separate claim you submit. An all-cause deductible is where you pay a cumulative deductible. What this means is that if your deductible is $200, you don’t pay anything beyond $200 (other than a co-payment or co-insurance) for the rest of the benefits period. A family deductible means that all family members on the same insurance policy contribute to one single deductible rather than each paying a separate deductible.
Major Medical Insurance Covered Expenses
Major medical insurance, be it comprehensive or supplemental covers a wide array and variety of services and procedures including, but not limited to:
* hospital stays
* outpatient services and private nursing care
* blood and lab work
* prescription drugs
* prosthetic devices
* ambulance services
* anesthesia and anesthesiologist services
* home healthcare services
* x-rays and radiological services
* medical equipment rental
* and many more!