by SEIU International

Major medical health insurance coverage is a popular low cost health care option and is available through most large health insurance companies. Major medical rates are typically substantially lower than conventional comprehensive plans and are popular with individuals and families that are mostly concerned with covering catastrophic claims.

What Does Major Medical Health Insurance Cover?

Most catastrophic expenses are covered, including inpatient and outpatient expenses, emergency room charges for illness and injury, facility fees, and professional fees charged by doctors, surgeons and nurses. Additional items that are generally covered include surgical procedures (in or out of the hospital), CAT scans, MRIs, radiation and chemotherapy, organ transplant drugs, room and board, operating room expenses, and prescription drugs in the hospital.

When Should Major Medical Health Insurance Be Used?

Since this type of low-cost policy often excludes most office visit (other than preventive) and prescription coverage, major medical plans are most popular when used in conjunction with Health Savings Accounts or persons that only need to cover catastrophic claims. Since premiums are typically hundreds, and sometimes thousands of dollars lower than comprehensive plans, the savings can be deposited into a separate account or used to pay other bills. The risk, of course, is that hospital claims will arise more often than anticipated, resulting in large out-of-pocket expenses.

What Is A High Deductible Health Plan (HDHP)?

An HDHP is required to have a Health Savings Account. The combination of an HDHP and a Health Savings Account provides traditional health insurance coverage and a tax-free option to help accumulate savings for future qualified medical expenses. The combination of both plans allows you to have much better control of your medical coverage and potentially save substantial amounts of money by lowering your premiums.

The HDHP minimum deductibles (,200 for individuals and ,400 for families) are higher than traditional health care, although a full range of preventive benefits is covered at 100% without having to meet a deductible or a waiting period. By using Network providers, a “Network-negotiated discount” will lower your out-of-pocket expenses.

What Is The Difference Between A Catastrophic Plan And A Major Medical Plan?

Actually, the two terms mean essentially the same thing. Both types of coverage are designed to reduce your premiums and protect against larger claims, as opposed to small office visit expenses.

How Will Recent National Health Care Reform Affect Major Medical Insurance Plans?

When most of the national health care reform changes become effective in 2014, health care coverage will become more streamlined with fewer available choices for the consumer. “High deductible” plans are currently one of the options that will be offered through “Exchange” programs to be administered by each state.

Brokers should also continue to play an active role in aiding consumers chose which plans are the best fit for their specific situation. Without brokers, it will become very difficult and confusing for consumers to accurately review their options. Also, many provisions of the proposed health care bill are being challenged, so it is possible that changes could occur between now and 2014. Online catastrophic health insurance rates should remain low between now and 2014.

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