Health Insurance Benefits

Health Insurance Benefits Explained

Optional health insurance benefits vary from insurer to insurer and may or may not be included as part of their standard policies. Separate policies can sometimes be written to include these health insurance benefits. Some of them are:

• Maternity
  
  
• Convalescent – Nursing home
  
  
• Emergency first-aid
  
  
• Home health care
  
  
• Mental infirmity
  
  
• Hospice care
  
  
• Prescription drugs
  
  
• Dread disease
  
  
• Outpatient treatment
  
  
• Dental
  
  
• Private duty nursing
  
  
• Vision

We will not cover all of these options, but will take a look at the most common health insurance benefits.

Maternity benefits are sometimes included in policies subject to certain conditions and limitations. The most usual limitation is a 10 month waiting period designed to prevent the purchase of health insurance just to cover pregnancy and childbirth expenses.

Interesting to note, however, group policies for employee groups of 15 or more are required by law to provide maternity benefits on the same basis as non-maternity benefits. This means that in a case such as this, the waiting period for these health insurance benefits would not apply unless non-maternity benefits also required a 10 month waiting period.

Aside from the group scenario above, many policies just exclude maternity benefits totally but make them available at extra cost. Where maternity health insurance benefits do apply, the benefit usually includes newborn care while the mother is in the hospital.

Other health insurance benefits that are sometimes available under the same maternity coverage might include cesarean deliveries, natural abortions and elective abortions.

Emergency first aid coverage applies to an accident that may call for immediate first-aid on the scene. This applies when a medical professional who just happens on the scene provides first-aid service he/she might bill the insured.

Sometimes treatment like this must be performed without the knowledge or assent of the insured. Some policies offer coverage for such contingencies and normally must incur within a very short time after an accident.

Mental infirmity historically has been excluded from most policies. However, in recent years more and more policies include this type of coverage but with limitations. The health insurance benefits for this are usually much lower than physical ailments and a stated percentage of the benefit paid for other types of medical care is included.

Common Exclusions And Limitations

Both disability income and medical expense policies limit or exclude coverage for certain types of injuries or illness. There is a difference between limitations and exclusions.

The mental infirmity policy limitations we discussed above is an example, whereas an exclusion is completely omitted from any coverage. It is important that you deal with a knowledgeable agent because state laws and policies may differ on specific items.

Some items that fall under common exclusions and limitations might be:

• Pre-existing conditions as defined by your policy and dictated by state law.
  
  
• Hernia however the growing trend is to cover the condition.
  
  
• Self-inflicted injuries
  
  
• Suicide
  
  
• War and/or acts of war that result in injury or death
  
  
• Military duty
  
  
• Non-commercial air travel
  
  
• Injury while committing a felony
  
  
• Injury, illness or death incurred while under the influence of alcohol or narcotics
  
  
• Cosmetic surgery unless for surgery required as a result of an accidental injury or a congenital defect
  
  
• Dental expense, unless resulting from accidental injury
  
  
• Vision correction such as eye exams, eyeglasses and contact lenses
  
  
• Care provided by governmental facility which is normally covered by the Veterans Administration or by workers compensation
  
  
• Sexually transmitted diseases
  
  
• Experimental procedures
  
  
• Organ transplant
  
  
• Infertility treatment and services
  
  
• Alcohol and drug abuse treatment

Up to this point we have discussed “basic” health insurance benefits that are designed to cover some hospital, medical and surgical costs that are primarily considered to be minor.

When purchased individually, these health insurance benefits can be substantially less than actual costs incurred. Here is where Major Medical coverage enters the picture.

More Health Insurance Information

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