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health insurance company
In other words, let’s say that the insurer determines that a certain surgical procedure has a prevailing value of $1500 and indicates that in the schedule included in your policy. That is considered the absolute value. Now, let’s say that there is another procedure not listed in the schedule that is say 50% less complicated as the $1500 procedure. In this case, the relative value would be $750 and that is the benefit amount that will be paid for the less complicated procedure.
The broad category of medical expense coverage provides a wide range of benefits for hospital, surgical and medical care. Other benefits may apply as well, such as private nurses, convalescent care, and more.
Basic surgical coverage can be included in the same policy as basic hospital and medical expense and are normally included in a schedule listing major commonly performed operations and the benefits payable for each. This gets a bit tricky and you need to be aware of how the insurance company determines the benefit.
Here is where Major Medical coverage enters the picture. Major Medical covers a broader range of medical expenses providing more complete coverage. Generally speaking, these more extensive types of policies fall into two categories: Comprehensive. This is the more traditional basic coverage and any other type of medical expenses are combined into a single policy. Supplemental. This coverage usually begins with a traditional basic policy. That coverage pays first and the major medical coverage is added to include expenses that are not covered by the basic policy.
The primary beneficiary is the first person in line to receive the benefit in the event of the death of the policy holder. They can also name a second beneficiary who would receive the benefit in the event the primary beneficiary dies before the insured. Some policies can include a third beneficiary who would be in line after the first two.
Benefit limitations placed on certain of the various coverages in a major medical policy are considered inside or internal limits. In other words, the policy may limit both room and board and number of days that will be paid. In this case, the period for hospital room and board will be whatever number of days that are specified. Other internal limits might be restrictions for convalescent are days, mental health, x-rays and similar items.
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