What Is Major Medical Coverage Insurance?
Major medical coverage insurance is the term used to refer to one particular form of what is usually referred to today as indemnity or fee-for-service health insurance.
Rising medical costs these days mean that we are increasingly moving away from traditional forms of health insurance and the original indemnity health insurance plan is now being replaced by a variety of other plans including health maintenance organization (HMO) plans, preferred provider organization (PPO) plans and point of service (POS) plans.
In essence indemnity health insurance plans are designed to cover unexpected medical expenses due to illness and injury and give plan holders considerable freedom in choosing where and from whom treatment is taken. Indemnity plan holders are also normally responsible for paying for their treatment and then reclaiming the cost from their insurer.
The newer plans by contrast focus much more upon routine medical care with the aim of avoiding unnecessary costs by keeping plan holders well and spotting problems at an early stage when they are hopefully easy to treat. These plans simplify administration for plan holders but also remove much of the freedom to decide where and from whom treatment is to be received.
Most people today will be covered by the newer forms of health insurance rather than by traditional indemnity plans in the main not only because of their lower cost but also because there is far less administration when it comes to making claims against your plan. In addition, an increasing number of employers who offer group health insurance plan membership to their employees are also choosing these newer plans. Nevertheless, there is still a significant number of people who prefer the freedom of choice which an indemnity plan gives them and it is here that you may wish to consider major medical insurance coverage.
Indemnity plans provide three types of coverage; basic health insurance, major medical insurance and comprehensive insurance.
Basic health insurance plans will vary from one insurer to the next but will normally cover hospital care (including room and board), some hospital services (such as x-rays and medication), surgery (whether performed in hospital or another suitable surgical center) and some doctors visits.
Major medical insurance plans by contrast are designed to cover treatment for long-term and high cost illnesses and injuries and both in and out-patient expenses associated with these illnesses.
Finally, comprehensive cover is simply a plan which includes both basic and major medical coverage.
Not surprisingly major medical insurance plans are a popular choice as many people are only too happy to bear the day to day cost of medical care but are worried about what they would do in the event of a major illness or accident which could entail considerable medical expense which might drag on for weeks, months or even years.
Unfortunately, the choice and security provided by a major medical insurance plan is reflected in the cost of indemnity plans in general and so it is increasingly becoming an option which many people would like to choose but which is simple becoming too expensive.
Autonomy: An ethical principle which, when applied to managed care, states that managed care organizations and their providers have a duty to respect the right of their members to make decisions about the course of their lives.
Indemnity wraparound policy: An out-of-plan product that an HMO offers through an agreement with an insurance company.
No balance billing provision: A provider contract clause which states that the provider agrees to accept the amount the plan pays for medical services as payment in full and not to bill plan members for additional amounts (except for copayments, coinsurance, and deductibles).
Report card: A set of performance measures applied uniformly to different health plans or providers.
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