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Other medical expense benefits fall into a category in addition to the hospital, surgical and medical benefits previously discussed. These optional benefits vary from insurer to insurer and may or may not include as part of their standard policies. Separate policies can sometimes be written to include these benefits. Some of them are:
- Maternity
- Convalescent – Nursing home
- Emergency first-aid
- Home health care
- Mental infirmity
- Hospice care
- Prescription drugs
- Dread disease
- Outpatient treatment
- Dental
- Private duty nursing
- Vision
We will not cover all of these options, but will let’s take a look at the most common.
Maternity benefits are sometimes included in policies subject to certain conditions and limitations. The most usual limitation is a 10 month waiting period designed to prevent the purchase of health insurance just to cover pregnancy and childbirth expenses. Interesting to note, however, group policies for employee groups of 15 or more are required by law to provide maternity benefits on the same basis as non-maternity benefits. This means that in a case such as this, the waiting period would not apply unless non-maternity benefits also required a 10 month waiting period.
Aside from the group scenario above, many policies just exclude maternity benefits totally but make them available at extra cost. Where maternity benefits do apply, the benefit usually includes newborn care while the mother is in the hospital.
Other benefits that are sometimes available under the same maternity coverage might include cesarean deliveries, natural abortions and elective abortions.
Emergency First Aid Coverage applies to an accident that may call for immediate first-aid on the scene. This applies when a medical professional who just happens on the scene provides first-aid service he/she might bill the insured. Sometimes treatment like this must be performed without the knowledge or assent of the insured. Some policies offer coverage for such contingencies and normally must incur within a very short time after an accident.
Mental Infirmity historically has been excluded from most policies. However, in recent years more and more policies include this type of coverage but with limitations. The benefits are usually much lower than physical ailments and a stated percentage of the benefit paid for other types of medical care is included.
Common exclusions and limitations. Both disability income and medical expense policies limit or exclude coverage for certain types of injuries or illness. There is a difference between limitations and exclusions. The mental infirmity policy limitations we discussed above is an example, whereas an exclusion is completely omitted from any coverage.
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