Major Medical Insurance Murrieta
Major medical insurance is a form of health care coverage that provides benefits for most types of medical expenses that may be incurred.
Offering more complete coverage with fewer gaps, major medical insurance covers a much broader range of medical expenses â€“ including those incurred both in and out of the hospital â€“ with generally higher individual benefits and policy maximum limits.
These more extensive medical insurance policies are divided into two general groups: comprehensive major medical insurance, in which the traditional basic coverages and essentially any other type of medical expense are combined into a single comprehensive policy; and supplemental major medical insurance, in which coverage begins with a traditional basic policy that pays first, with the major medical coverage added to pick up expenses left uncovered by the initial basic policy.
Let’s look at each of these groups and examine how the generally operate.
Comprehensive Major Medical
Most major medical policies begin paying benefits after the deductible is satisfied. The policy’s deductible is considered satisfied as long as the insured individual can show evidence of having incurred and paid the necessary covered expense. There are essentially two classes of comprehensive major medical plans: those that provide first dollar coverage, and those that do not.
With first dollar coverage, as soon as covered medical expenses are incurred, the policy immediately begins to pay benefits. Consequently, policies with first dollar coverage effectively have a deductible amount of zero. Without first dollar coverage, the insured must first pay out-of-pocket a specified deductible amount, and when that amount of incurred covered expenses has been paid, the policy will then begin to pay benefits.
Supplemental Major Medical
When a supplemental major medical policy is used, it typically backs up and enhances a basic policy that usually includes hospital, surgical and medical coverage along with an additional policy covering the broader range of medical expenses. Generally, the basic plan will pay covered expenses with no deductible, up to the policy’s limit. Above that limit, the supplemental policy is activated, operating in exactly the same manner as a comprehensive policy that does not provide first dollar coverage.
In simpler terms, after the basic policy’s limits are reached, the insured must pay a deductible, after which the supplemental major medical coverage begins to pay. Since the deductible actually occurs between the basic and supplemental policies, it’s often referred to as a corridor deductible. Like the comprehensive major medical plan, a supplemental policy is likely to include a stop-loss limit and a maximum lifetime benefit.