Health insurance policy

Question

Make a summary of the different kinds of medical coverage and major provisions of the health insurance policy.

Answer 1

The types of medical coverage are as follows

• Hospital insurance: This provides cover for specific benefits of daily hospital room and board and other normal hospital services and necessary supplies during hospital stays. This includes accidental hospitalization, birth-related care, etc

• Surgical insurance: This policy provides the benefits to pay for surgery related expenses. This can be combined with the hospital insurance and the combination will provide coverage for hospital stays as well as surgery. This includes surgeries such as bone marrow transplants, cosmetic and plastic surgery, hip, knee or joint replacements, cataract eye, etc.

• Physician insurance: This covers for physician charges both in and out of hospital and does not include surgery. It includes visits to physician, x-rays, lab tests, etc.

• Major medical coverage: It includes a broad range of medical expenses offering more complete coverage. Comprehensive policies are the traditional basic cover combined with other type of expenses necessary. Supplemental policies begin with traditional policy and add the expenses that are not included in the basic policy. The main difference between the two is that supplemental can distinguish between basic and major medical for reimbursement purposes, whereas comprehensive combines both and covers all types of expenses.

• Dental insurance: This covers some of the costs linked to dental care. This includes tooth decay and preventive treatments for dental problems but does not include treatment for missing teeth, sealants or dental implants.

• Vision insurance: This provides coverage for services rendered by eye care professionals like ophthalmologists and optometrists. This includes annual eye examination costs, which comprise of a complete evaluation of eyes with all tests for eye health and determination of the need for glasses.

• Indemnity insurance: This pays up and until a fixed amount when a claim is raised. This is certainly not a substitute for comprehensive health insurance, which is perceived wrongly. The premiums for these plans are generally lower. This covers hospitalization, outpatient care and physician services both in and out of hospital. However, this does not include illnesses or preventive care services and covers only injuries sustained in an accident.