| METLIFE'S HOSPITAL INDEMNITY INSURANCE IS A LIMITED BENEFIT GROUP INSURANCE POLICY. The policy is not intended to be a substitute for medical coverage and certain states may require the insured to have medical coverage to enroll for the coverage. The policy or its provisions may vary or be unavailable in some states. Prior hospital confinement may be required to receive certain benefits. There may be a preexisting condition limitation for hospital sickness benefits. MetLife’s Hospital Indemnity Insurance may be subject to benefit reductions that begin at age 65. Like most group accident and health insurance policies, policies offered by MetLife may contain certain exclusions, limitations and terms for keeping them in force. For complete details of coverage and availability, please refer to the group policy form GPNP12-AX, GPNP13-HI, GPNP16-HI or GPNP12-AX-PASG, or contact MetLife. Benefits are underwritten by Metropolitan Life Insurance Company, New York, New York. In certain states, availability of MetLife’s Group Hospital Indemnity Insurance is pending regulatory approval. Hospital does not include certain facilities such as nursing homes, convalescent care or extended care facilities. See MetLife's Disclosure Statement or Outline of Coverage/Disclosure Document for full details. Show
1 Rates are illustrative only. Please do not submit money. You must first obtain an application to obtain any coverage. Premium based on the individual rate for a 65-year-old in Alabama, with a 6 day, $100 hospital confinement benefit. Individual rates will vary based on your state, age at time of issue, coverage type, and the benefit amount you select. Rates are subject to change. 2 The term “hospital” does not include a clinic or facility, including a skilled nursing facility or an urgent care center, or a unit of a hospital for: Rehabilitation, convalescent care, custodial care, educational or nursing care for the aged, care for chemical dependence or alcohol dependence, or used exclusively for the treatment of mental and nervous disorders. 3 Minimum and maximum benefit amounts may vary by state and all benefits payable are subject to the terms and conditions of the policy. 4 Benefits received in excess of medical expenses may be considered taxable income. Consult your tax advisor. 5 Policy cannot be canceled as long as you pay your premium when due. The company reserves the right to increase premiums on a class basis. 6There will be a charge for each rider selected. Riders are not available in all states. THESE POLICIES PAY LIMITED BENEFITS ONLY. THEY DO NOT CONSTITUTE COMPREHESIVE HEALTH INSURANCE COVERAGE AND ARE NOT INTENDED TO COVER ALL MEDICAL EXPENSES. THIS COVERAGE DOES NOT SATISFY THE “MINIMIUM ESSENTIAL COVERAGE” OR INDIVIDUAL MANDATE REQUIREMENTS OF THE AFFORDABLE CARE ACT (ACA). THIS COVERAGE IS NOT MEDICAID OR MEDICARE SUPPLEMENT INSURANCE. THE LUMP SUM CANCER AND CANCER TREATMENT POLICIES ARE CANCER ONLY POLICIES. This website is designed as a marketing aid and is not to be construed as a contract for insurance. It provides a brief description of the important features of the policy. Full terms and conditions of coverage are defined by and governed by an issued policy. Please refer to the policy for the full terms and conditions of coverage. This is a solicitation for insurance. An insurance agent/producer may contact you. Product availability varies by state. These policies contain exclusions, limitations, reduction of benefits, and terms under which the policy may be continued in force or discontinued. For cost and complete details of coverage, contact your insurance agent/producer or the company. Cancer Treatment, Lump Sum Cancer, Lump Sum Heart Attack and Stroke, Hospital Indemnity and Individual Whole Life Insurance Policies are insured by Loyal American Life Insurance Company. Lump Sum Heart Attack and Stroke policy is not available in: ID, MA, NY, or VA. Lump Sum Cancer policy is not available in: ID, NY, VA or WY. Cancer Treatment policy is not available in: ID, MA, MN, NH, NJ, NY, UT, or WY. Hospital Indemnity policy is not available in: CA, CT, ID, NH, or NY. Whole Life policy is not available in: FL or NY. Accident Treatment policy is not available in: ID, NH, NY, or VA. All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Loyal American Life Insurance Company. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. Editorial Note: We earn a commission from partner links on Forbes Advisor. Commissions do not affect our editors' opinions or evaluations. Health insurance is something everybody needs. A good health insurance plan is the key to accessing the medical services you need at a price you can afford. The more you understand about how health insurance works, the better equipped you are to find the best health insurance plan for your needs. Here is a breakdown of the most important aspects of a health insurance plan. A health insurance policy covers many services, procedures and treatments. Here are a few examples of what health insurance typically covers. Featured Health Insurance Partners Offers plans in all 50 states and Washington, D.C. Number of providers in network About 1.2 million Physician copays start at $20 Offers plans in all 50 states and Washington, D.C. Number of providers in network About 1.7 million Physician copays start at $10 Offers plans in all 50 states and Washington, D.C. Number of providers in network About 1.5 million Physician copays start at $0 Hospital and doctor visitsHealth insurance covers the cost of visits to see your primary physician, specialists and other medical providers. It also covers when you get health care services at a hospital, whether for emergency care or surgeries, outpatient care, procedures or overnight stays. You might be responsible for the plan’s deductible, copayment and coinsurance costs. But as long as you remain in-network and your care is deemed medically necessary, the health insurance plan should pick up the lion’s share of the cost once you reach your plan’s deductible. Essential health benefitsWhen the Affordable Care Act passed, it guaranteed that plans offered on the health insurance marketplace cover at least these 10 essential health benefits:
Health insurance plans also must cover birth control and breastfeeding services. Preventive servicesHealth insurance plans must cover certain preventive health services at no cost to you. That means you can’t be charged a copay or coinsurance. These services can be divided into three categories: all adults, women and children. Preventive services required for all adultsPreventive services required for womenPreventive services required for childrenPrescriptionsMost health insurance plans are required to offer prescription drug coverage, but which medications are covered varies by insurer. Your plan has its own formulary or list of approved medications. You can find this list on the health insurer’s website. This list also should be part of the documents your insurer provides to you. You can also call your insurer to find out which drugs are on the list. In some cases, it might be possible to get an exception from your insurer to cover a medication not on its formulary. This is especially likely if none of the drugs on the formulary can treat your condition effectively. Contact your insurance company to learn more. Pre-existing conditionsHealth insurance companies that sold individual health insurance were once reluctant to cover care related to a pre-existing condition, which is a health issue that you already had before you looked for or actually purchased health insurance coverage. Insurers may decline coverage or charge exorbitant premiums. That changed with the passage of the Affordable Care Act. Health insurers can no longer deny coverage or charge more due to diagnosis of a pre-existing condition. What Does Health Insurance Not Cover?Health insurance doesn’t cover everything. Here are examples of health care services that might not be covered. Cosmetic proceduresCosmetic procedures include things that reshape or enhance parts of the body, generally with a goal of improving appearance. Health insurance doesn’t typically cover this type of care, although some plans might cover cosmetic procedures if deemed medically necessary. Fertility treatmentsFertility treatments aren’t among the essential health benefits guaranteed by the federal government, and many insurers don’t offer coverage for such treatments. But some states mandate that insurers cover at least some such services. New technology in products or servicesMany insurance companies will likely refuse to cover experimental or unapproved health care products and services that involve new technology. Before using such new treatments, make sure your insurer is on board with covering the new approach. Off-label prescriptionsAn off-label prescription generally means the medication is being used in a way that the U.S. Food and Drug Administration hasn’t approved. Your insurance company may or may not cover medications used this way, so it’s important to talk with your insurer to ensure such treatments will be covered. What to do if Your Health Insurance Plan Doesn’t Cover a Product or ServiceSome health insurance plans may not cover products or services you need. Understanding your coverage as much as possible will help you avoid surprises. It’s also possible that your health insurer may deny coverage for a claim after you already used a product or service. If this happens, and you believe you have coverage that applies, you have a right to request an internal appeal, in which the insurer will conduct a full and fair review of its decision. If your claim still isn’t approved, you can request an external review, in which a third party will have the final say over the claim. Is a Medical Necessity Covered?Health insurance companies use the term “medical necessity” to describe services that they cover. As a general rule, insurers will pay at least a portion of the cost for services that meet this definition. A service typically must be “medically necessary” before it will be covered. A doctor’s willingness to say that a service is “medically necessary” may help convince an insurer that the service is necessary. Other Things to Consider for Health InsuranceUnderstanding how your health insurance policy works is crucial to avoiding potentially costly mistakes. Here are some terms to understand: PreapprovalsHealth insurers use the preapproval process to decide whether a medication, procedure or service is medically necessary. That means you must get preapproval before pursuing these types of health care. If you do not, you may be responsible for the entire bill. In-network vs out-of-networkPhysicians, hospitals and other medical providers who agree to accept your health insurance are known as “in-network” providers. All other entities are “out-of-network.” Some insurance plans, such as health maintenance organization (HMO) and exclusive provider organization (EPO) plans, typically don’t cover out-of-network providers. That means you will be on the hook for all expenses incurred. In other cases, the plan will pay for some of the charges, but usually at a much lower percentage than for “in-network” entities. That’s generally the case for preferred provider organization (PPO) and point of service (POS) plans. Prescription drug costsHealth insurance plans typically cover the cost of prescription drugs. That doesn’t mean they will cover all medications, so make sure you understand which drugs are covered and at what rate. CopaymentA copayment is a fixed amount that you might owe for seeing a provider or even for undergoing a lab test or getting a prescription medication. A copay to see a specialist or visit an emergency room is generally more expensive than going to your primary care provider or visiting an urgent care center. DeductiblesA health insurance deductible is the amount you must pay out of pocket annually for health care services before your insurance kicks in. Deductible amounts can be high, often thousands of dollars. Some insurance companies pay for specific services even before you meet your deductible. Check with your insurer to find out if it offers these services. In addition, all plans sold on the marketplace must cover the full cost of some preventative benefits even before you meet your deductible. Once you meet your deductible, your health insurer will pay a portion of the costs and you pick up the rest. That’s called coinsurance. CoinsuranceCoinsurance is the percentage of health care costs that you are responsible to pay once you reach your deductible. For example, if your coinsurance is 20% and you are charged $100 for a health care service, you owe $20. Health insurance comes with an out-of-pocket maximum that you can be charged each year. This amount is usually several thousand dollars. Once you reach your out-of-pocket maximum, you’re not responsible for health care costs for the rest of the year. The health plan pays all of the costs when you receive care. Find The Best Health Insurance Companies Of 2023What Does Health Insurance Cover FAQIs health insurance really worth it?Health care services are potentially expensive, so nearly everyone can benefit from having health insurance coverage. Purchasing health insurance on the Affordable Care Act (ACA) marketplace is also more affordable than you may think, thanks to subsidies that the federal government provides to millions of Americans to reduce the cost. Those subsidies are based on your household income. What’s the worst that can happen if I don’t have health insurance?Without health insurance, you will likely be responsible for all your health care expenses. In some situations, this could be financially ruinous. The federal government notes that simply treating a broken leg can cost $7,500. Three days in the hospital might run you $30,000. And those are relatively minor costs compared to the hundreds of thousands of dollars it might cost to treat an especially serious or chronic condition if you don’t have health insurance. Can a hospital deny me care if I’m not covered by health insurance?An emergency room cannot refuse to treat a person simply because the patient does not have health insurance, so long as the care the person needs meets the standard of an emergency. The individual can still be charged for such services. In addition, once the emergency has passed, the hospital can discharge or transfer the patient. How much is health insurance?The average monthly health insurance premiums for a Bronze plan in the marketplace is $928, $1,217 for a Silver plan and $1,336 for a Gold plan. The exact cost of health insurance varies by multiple factors, including your age, location, insurance company and type of plan. Health insurance companies can’t use your gender or health status and pre-existing conditions when setting rates. What is not covered under hospitalization expense coverage?Which of the following services is NOT covered under a hospitalization expense policy? Surgeon's fees. (While an insured is hospitalized, the hospitalization expense coverage includes benefits for the cost of all of these services EXCEPT a surgeon's fees.)
What is meant by hospitalization insurance?Hospital Indemnity insurance, also called Hospitalization insurance or Hospital insurance, is a plan that pays you benefits when you are confined to a hospital, whether for planned or unplanned reasons, or for other medical services, depending on the policy.
What is covered under basic hospital expense coverage?Basic Hospital Expense Coverage – Covers a period of usually not less than 31 days of continuous in-hospital care and certain hospital outpatient services. Basic Medical-Surgical Expense Coverage – Covers costs associated with a necessary surgery, including a certain number of days of in-hospital care.
What is the purpose of hospital insurance?Hospital indemnity insurance supplements your existing health insurance coverage by helping pay expenses for hospital stays. Depending on the plan, hospital indemnity insurance gives you cash payments to help you pay for the added expenses that may come while you recover.
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What is covered by the hospitalisation insurance?
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