Major Med....?

TonyC

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I was looking at UShealth's Major Med.

Apparently, when you visit the emergency room....without being admitted....you have to pay out of pocket (which is comes out of your deductable).

Is this the same with every Major Medical Policy?
 
I was looking at UShealth's Major Med.

Apparently, when you visit the emergency room....without being admitted....you have to pay out of pocket (which is comes out of your deductable).

Is this the same with every Major Medical Policy?

Nope. There are several carriers that simply have an ER copay (deductible waived).
 
Most plans I sell have an accidental injury rider that pays the deductible.
 
This varies on the market. Most states and carriers ER is indeed subject to deductible on PPO or HSA style plans. This is a major difference between group and individual.

There are exceptions on high end plans. Some carriers (like Humana) offer accident riders, which of course does not cover sickness. There are also no shortage of accident supplements.

VBA used to have an ER supplement - but it was just discontinued. There might be some other ER supplements but I have not seen them.

Also on plans that have ER co pays, read the details - most say "facility charges only" - which is a nice way of saying not much is covered. If the doctor is a "contractor" or you go down the hall for a "CAT Scan" - this might be outside of the copay.

Read the policy in detail, this varies drastically.
 
wow...thanks guys. I feel silly not knowing the difference between accident and illness. Yes...UsHealth has a accident rider....but it does not cover illness unless you are admitted to the hospital.
 
The only carrier in MD that has a copay for ER is Coventry. All other carriers, ER visits go to the deductible and with most carriers if you're not admitted there's an additional fee.
 
Thanks John....Coventry has purchased a HMO down here called Vista.

Does Coventry also have a Major Med Co.?
 
Coventry in MD has 4 major med individual plans on the market. It's accept/reject only and the underwriting guides make it pretty clear that if they have pre-ex conditions it'll be a decline.

If my clients are perfectly healthy GR beats their plans and rates. If they have a condition it's off to Assurant so I can't find a place for Coventry.
 
Read all the exclusions tonyc, you may find exclusions for: work related sickness and injuries, weekend admitting on Fridays, amount of time that passes between injury and or sickness and the seeking of service, the type of facility, the actual admittance into a hospital as opposed to the outpatient service, so on, so on. Any major med company has tons of exclusions.
 
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