Supplemental Louisiana Health Insurance Plans

What are Supplemental Health Plans?

Supplemental health plans provide limited coverage and benefits for specified losses. You should use these policies as supplements rather than substitutes for basic or comprehensive health insurance. Because these policies are designed to only provide coverage for a specified disease or condition, you should read these policies very carefully, so that you will have a better understanding of the covered benefits.

Accident Only

These policies cover death, disability, hospital and medical care resulting from an accident. Benefits vary greatly. A variation of these types of policies, called accidental death and dismemberment, can pay additional benefits for death due to such things as motor vehicle or at-home accidents.

Cancer

Cancer policies provide limited benefits when the insured person is diagnosed with cancer (as defined in the policy contract). Most policies contain a schedule of benefits describing the amount of payments for "covered" cancer treatments. Not all forms of cancer are covered under these policies.

Many specified disease policies only provide coverage for the actual treatment of the specified disease and will not cover charges that do not directly treat the specified condition. For example, a person being treated for cancer requires chemotherapy, which may cause extreme nausea. An anti-nausea medication is prescribed to make the treatment more bearable. The insurer probably will not cover the drug since it is treating the nausea, not the cancer.

Critical Illness

Critical Illness policies pay a lump sum if you are diagnosed with a specified critical illness. The sum is paid directly to the insured, regardless of any other sources of income. Most policies define "critical illness" as stroke, heart attack, cancer that is life threatening, paralysis, deafness, organ transplant requirement, blindness, kidney failure, etc.

Dental

Dental insurance usually provides benefits for care and treatment of the teeth and gums. Benefits vary from policy to policy as some may cover 100 percent of preventative care (such as semi-annual check-ups or fluoride treatments) while others may only cover a portion of preventative care. Typically, dental insurance plans provide limited benefits for preventative, basic, major and orthodontic services. There is normally an annual benefit maximum for covered services. If any benefits for orthodontic procedures are included, they may be very limited and have a lifetime benefit maximum.

Disability Income

Disability Income policies pay a weekly or monthly income for a specific period if you suffer a disability and cannot continue to work. The disability may involve sickness, injury or a combination of the two.

The disability payment is usually a set dollar amount not to exceed a certain percentage of your income. Most disability income policies reduce benefits based on other income to which you may be entitled, such as sick leave, Social Security benefits, workers' compensation benefits or sabbatical pay. Be aware that some disability income policies contain an elimination period, measured from the start of each disability. During that time, no benefits are paid. Elimination periods vary, generally from 30 days to six months, depending on the policy. A policy with a longer elimination period may provide lower premium payments.

An insurance company paying for a disability claim may require the policyholder to provide a written doctor's report. The frequency of this requirement depends upon the particular policy. For example, a given insurance company may require such medical updates every month. In addition, the insurance company may monitor certain public activities by policyholders who file claims, which may fight fraud and keep insurance costs down.

Hospital Indemnity

Hospital Indemnity policies provide benefits for each day of hospital confinement. The benefits are usually specified dollar amounts and are not based on actual expense.

Home Health Care

Home Health Care policies cover services prescribed by a physician and provided by a Medicare-certified or a state-licensed home health care service. The care must help with activities of daily living or the supervision or protection of a patient with cognitive impairment (such as Alzheimer's disease or senility). Some policies offering nursing home coverage automatically offer home care as well.

Nursing Home Care

Nursing Home Care policies offer an alternative for some people and cover either one level or several levels of care such as custodial, intermediate and skilled. Cognitive impairment or the inability to perform one or more of the activities of daily living will activate the benefit trigger of this care.

Long-Term Care

Long-Term Care policies usually pay for skilled, intermediate and custodial care in a nursing home.

Benefits for personal care (custodial care) may also be provided if that care is received in approved facilities. These policies usually pay a fixed amount per day while a person is in a nursing home. Most policies contain waiting periods during which no benefits are paid.

Normally, long-term care policies pay only for expenses in facilities that are licensed by the state and/or participate in Medicaid and Medicare and meet the policy's definition of skilled, intermediate or custodial care. For this reason, it is important to find out about the types of nursing homes that are available in your area before you buy the policy.

Medicare Supplement

Medicare Supplement policies are designed to pay most medical expenses for people 65 or older, or for individuals under 65 receiving Social Security disability benefits. However, Medicare does not pay all expenses. As a result, you may consider purchasing a Medicare Supplement policy that helps pay for certain expenses, which can include deductibles not covered by Medicare.