What is a benefit level?
Benefit levels for out-of-network hospital care will place a maximum payable amount that the insurance company will pay if the patient seeks medical care outside of the provider network of that insurance company. These benefit levels are usually set at a daily maximum dollar amount. For example, the insurance company may state that they will pay a maximum of $300 per day for in-patient hospital care received at a non-participating hospital. These benefit levels are designed to encourage the patient to seek medical treatment in-network, thus lowering the costs to both the patient and the insurance company. Some medical insurance policies have benefit levels that apply to all covered services and can be set at annual maximums or lifetime maximums. Once the insurance company has paid claims up to this maximum, they are no longer liable for providing coverage for any medical care received by that insured member. Most PPO plans will have set maximum benefit levels of $1 million or more for a lifetime. Other plans may set maximum benefits levels on all covered benefits on an annual basis. Plans will annual benefit maximums will also set lifetime maximums. 1 CommentLeave a comment |
|
What is a benefit level?
Many health insurance plans will provide coverage for certain types of medical treatments, but only up to a certain amount. If a health plan refers to a maximum benefit level, this means that they will not honor claims that exceed this maximum benefit level. A benefit level can refer to the number of visits or the maximum dollar amount allowable for that benefit. For instance, the health insurance policy may state that office visits are covered at a specific co-payment amount, but only a specific number of visits are allowed each year for this co-payment amount. Other types of benefits that are often limited to benefit levels include prescription drugs, home health care visits, psychiatric visits, drug rehab, chiropractic visits and out-of-network care. Prescription coverage with benefit levels are usually set at a specific dollar amount. For example, the insurance company may offer prescription drug coverage, but only until the claims submitted for prescription drugs reach $1,000 per year. Benefit levels that pertain to office visits will indicate the number of allowable visits each year.
Hi
Can you tell me more about what types of insurance offers the best health benefits level for our situation. We are a family of four. One daughter 17 and one son 14. Both of us parents have been hit by the recession and are now without coverage. My husband was self-employed but had to close shop due to bad times. He used to have insurance through an association for small business owners but is not eligible anymore. Luckily none of us have any history of illness, but we need some kind of insurance in case of something bad happening. We have heard about these ‘limited-benefit’ plans and that they are much cheaper than normal. What kind of health benefits levels do they include? Are they a substitute for other insurance plans and how come we haven’t heard of them before? What could be the best choice for us?
Comment by Rosemary — May 27, 2009 @ 9:53 am