A medical expense reimbursement plan is a type of health policy that allows the insured to access health professionals and private clinics. This occurs as long as they are not arranged with the chosen company, and that said contracted company returns between 80% and 90% of the invoice paid in that center as it is not arranged.
In other words, this type of policy allows you to go to the medical center you want (whether it is within the insurer’s medical chart or not) paying out of pocket for the costs so that the company can later partially or reimburse the medical expenses.
How Does the Medical Expense Reimbursement Plan Work?
Health insurance with reimbursement has a simple operation; the client pays out of pocket for the costs of the medical services received, an investment that the insurer will later fully or partially reimburse.
Depending on each case and, of course, on the limits for reimbursement of expenses that the insured has contracted, which must be included in the policy, the company will determine the corresponding financial return in each scenario.
But, before doing so, the insured must send the proof that confirms the medical intervention, be it the original invoice, a request form, or any other information that is required.
Time is also an important factor, since the time limit for the request for reimbursement of medical expenses, and its granting by the insurance company, must be established in the conditions of the policy. Speed is usually required from both parties, to keep the medical expense reimbursement insurance claim process short and easy.
What Is the Refund Cap?
In medical expense reimbursement insurance, the caps are the maximum reimbursement limit, which may be associated with the number, type of expense, and/or amount of reimbursements requested, which you will find when reviewing your policy. So, in case we had any questions, we already know what medical insurance with reimbursement is.
What Are the Differences Between Reimbursement Insurance and Medical Insurance?
When we refer to medical insurance, the payment method and the infinite availability of health means are the two main differences concerning a medical plan product. In these, the client has the facility of a specific and closed list of both professionals and health centers in which he can request a care service.
While in the latter the range is reduced to the offer of the health insurance company, in the insurance with reimbursement the possibilities are unlimited, and the capacity of choice for the insured is total and covers all their possible demands, without a maximum limit.
The good thing with these policies is that you don’t have to deal with copays or deductibles on health insurance. It is just attending and then negotiating the return of the invoice paid by yourself. Now, you must know how to choose the right insurer for this type of service.
When Is Your Best Option to Opt for Reimbursement Health Insurance?
It will always depend on the perspective, economic, and health conditions of the insured. It should be noted that medical expense reimbursement insurance is the best option in terms of freedom and the number of options available; although the cost of medical expenses can be significantly higher than that of medical directory products.
Therefore, it depends a lot on the economic capacity of each one. However, there are other factors at play that can make you decide on one modality or another.
For example, if you have a stable residence or frequently move your address; if your state of health is delicate or solid and requires more or less frequent medical attention; or if you have in mind a well-known professional or a highly trusted medical center that does not have an agreement with the insurer and whose services you do not want to give up.
Are Coverages Lost in a Medical Expense Reimbursement Insurance?
Completely false. Hiring reimbursement insurance not only expands the healthcare capacity and medical services available in any of the specialties but also allows you to have the same type of facilities as other types of policies.
Read More: What is An Out-Of-Pocket Maximum?