• Aetna
• Assurant
• Blue Cross and Blue Shield

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• Celtic
• Humana

• Supplemental Medigap Insurance
• Medicare Advantage Insurance
• American Pioneer Life

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• Blue Cross and Blue Shield
• PUP
• Pennsylvania Life
• SecureHorizons by UnitedHealthcare
• Unicare
• WellCare

Types of Traditional Florida Health Insurance Care Coverage

Types of Traditional Care

Basic medical insurance
(hospital/medical/surgical)

Hospital insurance usually pays a portion of your room and board. It may also pay some expenses for other hospital services, such as operating room use, laboratory tests and X-rays. Medical/surgical insurance helps pay for surgical and related costs (either in the hospital or doctor's ofice), and may pay for anesthesiology. It may also pay doctor fees for medical visits when you receive hospital care other than surgery. Payments for surgical expenses are usually ixed amounts based on a surgical fee schedule. Insurance companies use fee schedules to determine the average cost of a procedure according to usual, customary and reasonable charges.

• Usual refers to the fee a doctor normally charges for a procedure.
• Customary involves the range of usual fees charged by doctors of the same specialty in a given geographic area for a speciic procedure.
• Reasonable applies to a fee that differs from the "usual or customary" charges because of unusual circumstances. The procedure may involve medical complications that require additional time, skill and expertise. This provision limits the amount the insurance company will pay under your policy. If possible, check what your insurer will pay prior to the delivery of medical services subject to a usual, customary or reasonable rate.

Basic medical insurance policies offer consumers differing beneits for room and board, physician, surgical and miscellaneous expenses. You should carefully check to see if policies offer equal beneits when comparing premium rates.

Major medical insurance

These policies provide protection against the high costs of hospitalization, injuries and serious or ongoing illnesses. Other possible coverages include the cost of blood transfusions, drugs and out-of-hospital costs, such as doctor visits. Most group health policies fall under the category of major medical policies. This category also includes the basic and standard plans issued under small group health access coverage (see "Group Plans").

Major medical policies cost extra and provide more beneits than basic policies. A major medical policy normally pays 80 percent of covered expenses, after you pay the deductible. Insurance companies use fee schedules to determine the average cost of a procedure; however, this cost may differ from the actual charge you receive. Many PPO plans stipulate that the provider may not charge for the actual cost in excess of the usual and customary amount.

Maximum out-of-pocket limits restrict the amount of coinsurance you pay. Not all policies include such limits, but those that do pay 100 percent of remaining covered expenses after you pay a stated amount of coinsurance.