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Asked: Apr 25, 2010

What is a benefit level?

Categories: In Nevada
Plan Types: In Other

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Many health insurance plans will provide coverage for certain types of medical treatments, but only up to a certain amount. If a health plan refers to a maimum benefit level, this means that they will not honor claims that eceed this maimum benefit level. A benefit level can refer to the number of visits or the maimum dollar amount allowable for that benefit. For instance, the health insurance policy may state that office visits are covered at a specific co-payment amount, but only a specific number of visits are allowed each year for this co-payment amount. Other types of benefits that are often limited to benefit levels include prescription drugs, home health care visits, psychiatric visits, drug rehab, chiropractic visits and out-of-network care. Prescription coverage with benefit levels are usually set at a specific dollar amount. For eample, the insurance company may offer prescription drug coverage, but only until the claims submitted for prescription drugs reach $1,000 per year. Benefit levels that pertain to office visits will indicate the number of allowable visits each year. Benefit levels for out-of-network hospital care will place a maimum payable amount that the insurance company will pay if the patient seeks medical care outside of the provider network of that insurance company. These benefit levels are usually set at a daily maimum dollar amount. For eample, the insurance company may state that they will pay a maimum of $300 per day for in-patient hospital care received at a non-participating hospital. These benefit levels are designed to encourage the patient to seek medical treatment in-network, thus lowering the costs to both the patient and the insurance company. Some medical insurance policies have benefit levels that apply to all covered services and can be set at annual maimums or lifetime maimums. Once the insurance company has paid claims up to this maimum, they are no longer liable for providing coverage for any medical care received by that insured member. Most PPO plans will have set maimum benefit levels of $1 million or more for a lifetime. Other plans may set maimum benefits levels on all covered benefits on an annual basis. Plans will annual benefit maimums will also set lifetime maimums.

Answered: Apr 28, 2010

 

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