Individual Healthcare Programs and Prescription Assistance Programs For The United States

Nov 27 2009

By John Henderson

Individual health coverage offers reimbursement for health care. Prescription assistance programs may be included in some plans. Various policies may possibly provide for payment of health bills incurred on a reimbursement basis by paying benefits to the policy holder, payment on a service basis by paying those who supply the services directly, or payment of an indemnity by paying a prearranged sum regardless of the total charged for medical visits. Health expense or hospitalization insurance may well be written on an individual or group basis. A few of these policies will provide prescription help.

While there are several types of benefits to be had, private health expense insurance might usually be categorized as basic medical expense insurance, major medical insurance, comprehensive medical insurance, and special policies. These policies should cover prescriptions because prescription drugs help so many patients. A large amount of these policies have essentially been replaced by managed care options and are no longer available as stand-alone plans. These types of programs have been adapted and replaced in answer to changes in the health care field relative to cost control and market competition.

Basic healthcare insurance provided by a personal medical expense plan includes hospital expense, surgical expense and medical expense. These three basics may possibly be sold together or separately. Normally this is written as “first dollar” coverage, which means it does not include a deductible.

Like the name implies, hospital expense medical insurance provides benefits for expenses incurred during hospitalization. Hospital indemnities are customarily classified into two broad categories:

• Room and board, plus nursing care and special diets

• Miscellaneous health charges, including x-rays, laboratory fees, prescriptions, medical supplies, and operating and treatment rooms

In several cases, surgical benefits possibly will be integrated for specific types of surgery and associated expenses. Hospital expense coverage offers benefits for daily hospital room and board and assorted hospital charges whilst the insured person is confined to the hospital. The policy can provide for a guaranteed dollar amount for the daily hospital room and board benefit, though the tendency is in the direction of insurance of not more than the semiprivate room rate unless a private room is medically required. The room and board benefit may well be paid on either an indemnity basis or a reimbursement basis, depending on the individual policy.

Indemnity plans are occasionally called dollar amount plans. Room and board rates vary by geographic location, but it is not uncommon to discover room and board rates ranging from $150 to $1000 per day or more.

Typically, the maximum number of days is from 20 to 20 . More commonly, room and board charges are paid on a reimbursement basis. This is {frequently called an expenses incurred basis~This is also known as a expenses incurred basis~This is often times called a expenses incurred basis}. Under this arrangement, the health insurance will pay in one of two methods.

• The actual charges for a semiprivate room are covered.

• A percentage of the actual charge is paid, with no particular dollar limit.

Under the first reimbursement option, the health insurance company will pay the full actual semiprivate room rate, regardless of what it is. Under the second reimbursement option, the insurance company pays a specific percentage, regardless of what the actual charges are. A universal percentage is 80%.

To sum up, with the actual expenses type of reimbursement policy, the health insurance will pay the actual amount charged for a semiprivate room without regard to a specific dollar limit. With the percentage type of reimbursement health insurance, the program may pay a certain percentage of the actual bill.