What is a Health Benefits Plan?
What if your insurance company listened to what you wanted and built a health insurance product around your needs? What you would get is a Limited Medical plan. Health benefits plans help with the high out of pocket costs and lost income problems that often accompany traditional health insurance. Consequently, Limited Medical plans can be used to supplement Obamacare or short-term medical insurance. Moreover, alongside the financial help they provide,these low-cost plans also include other types of services like 24-hour a day telemedicine access and prescription drug discount programs.
Limited Medical plans work differently than many insurance plans you may be familiar with. Unlike major medical plans like those found on Affordable Care Act (Obamacare) exchanges or short-term medical insurance, these health benefits plans offer defined dollar benefits that are paid without the enrollee first meeting a deductible or other out of pocket condition. In other words, Limited Medical plans pay a set amount of money when the enrollee experiences covered medical events with the payment amount varying depending on the medical event.
Depending on the health insurance benefit plan, payments may be made directly to the enrollee to offset out of pocket expenses or lost income, or it may be paid directly to the enrollee’s health care provider.
Depending on the specific Limited Medical plan, benefits may include:
This benefit pays fixed amounts for covered medical events provided at a hospital.
Accidental Injury Insurance:
This benefit pays fixed amounts in the event of a covered accident resulting in an injury that required medical care.
Critical Illness Insurance:
This benefit pays fixed amounts upon the diagnosis of a covered critical condition such as cancer or a heart attack.
This service provides 24 hour a day access to health care providers by phone or the internet.
This service provides discounts on the retail price for thousands of medications at participating pharmacies nationwide.
How Does a Limited Benefit Medical Indemnity Insurance Plan Work with Your Major Medical Health Plan
By combining a health benefits plan with your major medical plan, you can maximize your financial protection and reduce hassles often associated with health insurance--high deductibles, out of pocket expenses, and income losses associated with illness.
Limited Medical plans are a great option for those who want to control their medical expenses. With Obamacare and short-term health plans, you will often see deductibles and out of pockets of several thousand dollars. With a health benefits plan you get “first dollar” coverage. This means that you do not need to hit specific deductibles or out of pocket amounts in order to receive your benefits. Instead a specific defined dollar amount is sent to you or your provider depending on the medical event. You can use this money to pay for out-of-pocket expenses related to your accident or illness including your deductible or out of pocket maximum. It is important to note that with a health benefit plan, if you reach your maximum monetary benefit for the year you will not be eligible for additional payments until your plan’s renewal year.
Health benefits plans pay a fixed-cash benefit for covered accidents or sickness even when the same accident or sickness is covered by your existing major medical coverage.
Major medical plans use a model that covers more health situations. Obamacare, for example, will cover pre-existing conditions and preventative care while short term medical insurance will cover many conditions that occur after the effective date of your insurance plan. Major medical has higher dollar protection but often requires you to meet the plan deductible first. In 2017, the average deductible for an Obamacare bronze plan is over $6,000.*
Limited Medical plans often include services such as telemedicine that may not be included within your existing major medical coverage.
No. Limited Medical is designed to supplement your existing major medical insurance plan.
If major medical insurance is not available to you--because of Medicaid ineligibility, medical underwriting, immigration status, or other reasons--do not go uninsured. Limited Medical can help with out of pocket expenses and income loss while you seek major medical coverage. Do not go without health insurance.