Producers must deliver a policy to an applicant within 7 business days after they received it for delivery Show • An Outline of Coverage for a Medicare Supplement policy MUST be given to the applicant at the • A description of policy benefits must be included in an outline of coverage for a Medicare supplement insurance policy • The marketing of Medicare Supplements is regulated to prevent sales of excessive insurance, • The producer who solicits the application is primarily responsible for determining the • When a Medicare supplement policy is purchased during the open enrollment period, the policy • Free-look period for Medicare Supplements is 30 days • The open enrollment period for
Medicare (and Medicare Supplements) begin 3 months before • An insurer may exclude coverage for a preexisting condition on a Medicare Supplement Policy • No provision of any of the Medicare supplement plans duplicates benefits provided under • If a replacement policy, the replacing policy may not impose any time period exclusions for pre-existing conditions as long as there was no gap in coverage for more than 63 days Recommended textbook solutions
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Essentials of Business Communication10th EditionDana Loewy, Mary Ellen Guffey 631 solutions Private health insurance cover is generally divided into hospital cover, general treatment cover (also known as ancillary or extras cover) and ambulance cover. Private hospital policies give you a choice of doctor and cover to be a private patient in a public or private hospital. General treatment policies cover treatments outside of hospital such as dental, optical, physiotherapy or pharmacy. Not all policies cover all services - check with your insurer to find out what is included on your policy and what you may need to pay for yourself. You can purchase these policies separately, or as a 'combined' policy. morePrivate health insurance cover is generally divided into hospital cover, general treatment cover (also known as ancillary or extras cover) and ambulance cover. Ambulance cover may be available separately, combined with other policies, or in some cases is covered by your state government. In Australia, private health insurance is 'community-rated', rather than 'risk-rated' like most forms of insurance. Private health insurers cannot refuse to insure any person, and must charge everyone the same premium for the same level of cover, despite their risk profile and likelihood of using health services. There are different types of cover that offer different benefits. Check with your health insurer to be sure of exactly what you are covered for. Hospital CoverWith hospital cover you have the right to choose your own doctor, and decide whether you will be treated at a public or a private hospital that your doctor attends. If you are a private patient at a private hospital, you may also have more choice as to when you are admitted to hospital. If you are a private patient in a public hospital, public hospital waiting lists still apply. When you are admitted to hospital, you have the following treatment options:
Generally, any medical services which Medicare covers and are listed under the Medicare Benefits Schedule (MBS) can also be covered to some extent by private hospital insurance. Services which are not listed on the MBS, such as elective cosmetic surgery or laser eye surgery, are only covered by private hospital insurance to a limited extent or may not be covered at all, depending on the policy. What is covered by private hospital policies?Every health insurer offers policies with different levels of cover. Generally, the more expensive policies cover a wider range of services, while the lower cost policies will limit what services will be covered in a private hospital. Four new tiers of hospital cover began rolling out from 1 April 2019 and became mandatory from 1 April 2020. All hospital insurance policies are classified as Gold, Silver, Bronze or Basic. For more information about the new tiers, see Product tiers & Clinical categories. As with any other insurance policy, you can manage your cover by choosing comprehensive cover with higher premiums, or pay lower premiums for reduced cover. You can also reduce your premiums by opting to pay some of the costs through an excess or co-payment. For more information about hospital cover, see Private Health Insurance Basics. What may not be covered?The health insurance policy you buy will have some limitations on hospital treatment, which might include:
General Treatment CoverGeneral treatment cover (also called ancillary cover or extras cover) provides insurance against some or all costs of treatment by ancillary health service providers. The extent of your cover depends on the type of policy you select and may include services such as:
What may not be covered?Nearly all services covered under general treatment are only covered to a limited extent. There are various limits that may apply, for example a limit per service, per year, or lifetime limits. Some services may not be covered at all. You should check the Private Health Information Statement about any policy you are interested in, and seek information from your insurer for details of these limitations. AmbulanceMedicare does not cover the cost of emergency or other ambulance services. You can organise cover for this service as part of your hospital or general treatment cover, or as a stand-alone cover. The options for ambulance cover vary depending on what state or territory you live in. For further information please see the Ambulance section of the website. Broader Health CoverPrivate health insurers can cover a wide variety of clinically appropriate alternatives to hospital treatment. This can include treatment provided in your own home or in community healthcare clinics (known as hospital substitute treatment), as well as programs to manage or prevent chronic disease. It is not mandatory for health insurers to offer cover for these services. Participation in these programs may be subject to your level of cover and eligibility criteria, so check with your insurer for more information. Common examples of hospital substitute treatment include:
Common examples of chronic disease management include:
What hospital covers do?Hospital cover helps with the costs of treatment as a private patient in hospital. If you have private hospital cover, you can choose to be treated as a private patient in a public hospital, private hospital or day hospital facility.
What is basic hospital cover?What is Basic Cover? Basic cover is the entry level into private health insurance. It covers you for a limited range of services and usually excludes a wide range of hospital treatments. These treatments will vary depending on the insurer and type of policy you choose.
What does the hospitalization expense portion cover?The hospitalization expense of a Basic Medical Expense policy pays for hospital room and board. The provision in a Major Medical policy that requires the insurance company pay only part of a loss and the insured to pay the balance is known as coinsurance.
What is not covered by private health insurance?By law, private health insurance does not offer cover for out-of-hospital medical services including: GP visits. consultations with specialists in their rooms. out-of-hospital diagnostic imaging and tests.
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A hospital or medical expense policy will typically cover dental treatment
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