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Premium: The amount you or your employer pays in exchange for insurance coverage.
Complaints. HMOs must be set up to handle coverage complaints and care complaints. HMO members must receive a document that spells out how complaints can be registered.
Some policies contain limitations on preexisting medical conditions that you may have before your insurance takes effect. Others contain an elimination period, which means that benefits will not be paid until after you have been hospitalized for a specified number of days. When you apply for the policy, you may be allowed to choose among two or three elimination periods, with different premiums for each. Although you can reduce your premiums by choosing a longer elimination period, you should bear in mind that most patients are hospitalized for relatively brief periods of time.
Long-term care policies cover the medical care, nursing care, and other assistance you might need if you ever have a chronic illness or disability that leaves you unable to care for yourself for an extended period of time. These services generally are not covered by other health insurance. You may receive long-term care in a nursing home or in your own home.
Hospital expense benefits provide for expenses incurred during hospitalization. Indemnities usually fall under two broad groups: Room and board – including nursing care and special dietary requirements, Miscellaneous medical expenses – including x-rays, lab work, medications, medical supplies and operating and special treatment rooms.
Policies may be written as such that they may be limited to only one or two types of coverage like hospital or miscellaneous medical costs or surgical expenses. These are known as basic plans.
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