Individual & Family Health
Designed for Individuals and Families, a Comprehensive Major Medical plan that offers all 10 Essential Health Benefits, required in ACA qualified plans. The most significant benefit of a major medical plan is an accessible “network and pre-negotiated costs“.
By participating in Major Medical insurance, the participant has access to: doctors, hospitals, medical facilities, pharmacies, preventative and wellness services; including maternity, mental health services, and all on the pre-negotiated rate, established by the insurance provider.
Thus, instead of having to pay a “retail billing” cost for medical services, a covered participant will to limited to paying the annual deductible, coinsurance factor, and any copays, for routine services. This significantly lowers the legal liability of the insured person.
Currently on the US health insurance market, you will find “indemnity plans” which offer a fixed cost for services provided in a hospital or outpatient setting. The insurance carrier may provide “hospital inpatient” services; but, each service has a “specific coverage amount” or “scheduled payment” associated with the service, per day or per admission. Likewise, the same limited pay formula is used for outpatient service at the doctor’s office or a free standing facility. Limited pay plans leave the insured paying a significant portion of the claim.
The next type of plan found in the US market is called the Short Term Health Plan. This plan can offer a more comprehensive array of benefits to the consumer, but is limited to a “12 to 36 months” coverage period. Once the coverage period has elapsed, the benefits terminate. The consumer must “reapply for another benefit period, subject to any claims paid during the initial plan period. Certain claims may invalidate a future application for benefits.
- Many of these plans will offer ancillary benefits, such as accident plans to cover costs not provided by either indemnity or short term plans.
- Also, critical care plans, designed to cover claims due to a heart-attack, stroke, or internal cancer diagnosis, may help fill in the gaps of the base policy.
- Some agents will also provide hospital ancillary polices, to supplement additional cash benefits for inpatient hospital claims.
- Attaching some ancillary cash plans can help eliminate deductibles and coinsurance exposure – the extra costs of an ancillary policy simply reveals the true lack of coverage in the base policy design.
- With a comprehensive major medical policy, you will again find all the coverage’s meeting the ACA requirement of the 10 essential benefits.
- Virtual Visit or Telemedicine is normally covered at a $0 Copay.
- Standard Plans offer an Annual Deductible range from $0 to $8,000 per year.
- An HSA option is available.
- Once the “deductible and Coinsurance” requirements are met, a covered member will enjoy 100% in network coverage.
- Claims paid, within the plan network, should have No balance billing once the out of pocket maximums are met during the calendar year.
Optional Coverages include: Gap, Dental, Vision, Disability and Life.
