Many individuals and families enjoy the freedom that is available in having a comprehensive or major medical plan for their healthcare coverage. While these plans typically cost more than the average fees charged for managed care policies, the trade-offs can be well worthwhile. If you are considering the purchase of this type of policy from one of the licensed health insurance companies in Florida, there are some basic policy terms that you should understand before you sign your name to an agreement.
One of the most important terms to know in your comprehensive policy is your deductible. The deductible is the amount of medical expenses you will have to pay before your insurance benefits will kick in. The deductible is reset annually, meaning you will have to pay that amount each year and then your insurance company will begin to pay a percentage of your eligible medical expenses for the remainder of that calendar year. A general rule of thumb when it comes to the deductible is that the lower your deductible, the higher your premium will be.
Co-insurance is another important term to understand. The co-insurance rate is the percentage of the medical expenses you will have to pay. So, if you take out an 80-20 plan, you will have to pay a co-insurance rate of 20%, meaning your bill will be only 20% of the negotiated rate submitted by the healthcare provider. Keep in mind that health insurance companies in Florida will only pay the other percent of the bill after you have met the deductible set in your policy.
Health insurance companies in Florida that offer comprehensive or major medical plans should also provide consumers with a maximum out of pocket amount. The out of pocket maximum is the total amount you should have to pay on an annual basis for your medical expenses. That amount includes your portion of co-insurance and your deductible. If your medical expenses exceed the out of pocket maximum, the insurance company will pay the full price of those expenses. Your policy will also include a lifetime payment maximum. So be aware that when your medical expenses exceed that lifetime maximum, your insurance company is no longer obligated to pay your bills. These are just a few of the basics terms of a major medical or comprehensive policy. Make certain you feel comfortable with the levels of your health coverage before making a commitment.