Buyer Beware: Scheduled Benefit Policy: Have you made this mistake?

This is a typical scheduled benefit plan. I advise my customers to stay away from these types of plans at all cost if possible. In my opinion they just don’t offer enough protection.

What does this benefit outline mean:

• Deductible amnount is only                          $500.00
• Primary Daily Hospital Expense Benefit         $2,000.00
  What it does say here is that it’s limited to the first 10 days in the hospital.
• Secondary Daily Hospital Expense Benefit    $1,000.00
• Maximum Hospital Expense Benefit               $50,000.00
• Maximum Intensive Care Benefit                   $10,000.00
• Maximum Outpatient Benefit                         $300.00

This is enough to make my point without even getting into the rest of the benefit outline. This is an actual case that I recently ran across. This person went into the emergency room with severe intestinal cramping. They were dignosed with Diverticulitis. No laughing matter, believe me. This person was admitted to the hospital and had a 6 inch section of their colon removed. Patient was in the hospital the first time for a total of 6 days. The bill, a whopping $50,000.00, came a couple months later for the hospital stay. The carrier would pay according to this scheduled benefit only $12,000 towards the hospital bill. 6 times the daily maximum of $2,000.00. We’re not considering the surgical benefit which was very limited in the first place. So what happened to the rest of the bill you might ask? The patient has to come up with it. They are approximately $38,000.00 out of pocket. Not a very pretty picture. The agent had said they would be covered 100% after this benefit level. What this policy really means is that the stated amount is the absolute maximum the carrier will pay in the event of a claim. They were not told the truth. The customer had no idea what this scheduled benefit really meant. After explaining it to them they told me they would have never bought it had they known.

 

For comparison sake. Lets say this customer had a Health Savings Account type major medical policy with a high deductible of $2,700. What would have happened. The major medical would have paid the bill in full minus the $2,700 deductible. So the customer would have been $2,700.00 out of pocket. They would also have met their yearly deductible, so every claim the rest of the year would have been paid in full. To top it all off the monthly premium for the HSA (Health Savings Account) would have saved this customer a little over $100.00 a month. This savings could have been put into a health savings account and written off on their taxes. 

Customers should ask a lot of questions. If you are still unsure get a second opinion. Call Focus Insurance Group, Inc. We specialize in health insurance. You can run a competitive Illinois health insurance quote directly from our website. After entering the basic information we need to run a quote. You will get a list of different plans (quotes) to choose from. You can also pick up to four plan designs at a time and do a side by side comparison of the plans your interested in. This will give you the information you need to make a qualified decision. No agent will be in your living room pressuring you to sign on the dotted line. 

To run a free competitive quote go to: www.focusinsgroup.com

Tags: Add new tag, Focus Insurance Group, health savings accounts, hsa, Illinois health insurance, Illinois health insurance quotes

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