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Health insurance is designed to protect again two types of economic loss. Loss of income and expenses for medical care which places them in either of two broad policy categories: Disability income policies ,Medical expense policies.
Hospital-surgical policies, sometimes called basic health insurance, provide benefits when you have a covered condition that requires hospitalization. These benefits typically include room and board and other hospital services, surgery, physicians’ non surgical services that are performed in a hospital, expenses for diagnostic X-rays and laboratory tests, and room and board in an extended care facility.
Individual health insurance companies are much more limited than group insurance companies in their ability to spread risk, so the laws concerning i ndividual health insurance are different in most states. This means that applicants for individual insurance will need to complete a brief medical questionnaire when applying for benefits and, unlike a group insurance policy, in most states a company can decide not to cover people with very serious medical conditions (e.g., HIV or cancer), deeming them “uninsurable.”
Determining when a benefit must be paid can be one of two different ways. The benefit period might begin either on the first day of an injury or illness or on the date that the insured meets the deductible and can extend up to two years. Or, the benefit period may cease at the end of a calendar year and begin with a new deductible.
To find out about each state's specific requirements regarding individual health insurance policies, please see NAHU's Health Care Coverage Options Database. The database also contains contact information for the state regulators of individual health insurance policies to use if you have questions or concerns.
Some disability policies use a probationary period that begins when a policy goes into effect and no benefits are paid during this period. It varies but is often 15 or 30 days and sometimes up to 60 days for long-term policies.
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