Hassle-Free Health Coverage: Chapter 4 Summary

Major medical coverage is considered by many people with histories of health problems to be a realistic approach to getting indemnity-type coverage. The major medical plan provides a supply of money to be used over the lifetime of the insured.

Major medical plans are characterized by deductible, coinsurance and stop-loss provisions. After the deductible is satisfied, you and your insurance company coinsure claims expenses. But coinsurance only applies up to a pre-set stop-loss amount. Once the stop-loss is reached, the insurance company takes over paying the claim in full.

(Most major medical plans contain an annual restoration provision whereby a small amount of money is restored to the plan each year after plan dollars have been used to pay medical expenses.)

Expenses are covered based on the premise of UCR fees. The plan's coinsurance provisions will provide coverage for those expenses deemed reasonable and customary by geographical reason per the research of the insurance company.

Some people supplement major medical coverage with basic medical expense coverage to create a comprehensive health insurance package. This complex approach is made necessary by the fact that many people can't qualify for or afford traditional indemnity coverage.