About Limited Benefits
Limited Benefit plans (also referred to as “Limited Medical” or “mini-med” plans) are designed to provide affordable access to quality healthcare services for the uninsured who cannot access conventional, more comprehensive healthcare plans for reasons of cost or health status.
Our Frequently Asked Questions (FAQs) are designed to help you decide whether a Limited Benefit Plan is the right choice for you, right now.
Limited Benefit plans are not suitable for everyone but they play a key role in insuring individuals who might otherwise be uninsured. Generally, Limited Benefit plans appeal to:
- Part-time workers;
- Employees residing in “waiting periods” required for employer-based healthcare coverage;
- New job seekers who might use “limited benefits” to bridge the gap in healthcare coverage normally available at the workplace; and
- Individuals who cannot qualify for or afford individual Major Medical Insurance.
Limited Benefit plans are offered on a guarantee-issue basis, which means that coverage cannot be denied based on the health status of the applicant or their family members. These plans can be less expensive than individual comprehensive coverage plans because the plan reimburses at a fixed, predetermined amount depending on the policy. It does not serve to provide a cap on the consumer’s total out-of-pocket costs. By providing “limited benefits” that do not completely cover or cap out-of-pocket exposure, these plans help consumers to partially defray the costs of their healthcare but generally at a price that is less than typical Major Medical plans. This is how Limited Benefit plans can be made available to consumers who otherwise could not access Major Medical coverage.
Applicants for Limited Benefit plans should review reimbursement rates beforehand and consider whether the coverage provided is consistent with an applicant’s anticipated healthcare utilization and ongoing healthcare needs.
While comprehensive major medical coverage is certainly preferred and recommended for all, it is important to note that limited benefit plans do provide an alternate choice providing various levels of coverage across a wide array of important healthcare services. These services include:
- Preventive Care
- Physician Office Visits
- Emergency Room
- Diagnostic Testing
- In-Patient Hospital Confinement
- Surgery
It’s important you know that our Limited Benefit insurance has a number of specific limitations and other restrictions on the number and dollar amount of certain benefits. Please note that not all services are considered covered expenses under each of these categories. You should carefully review the policy or consult your insurance agent to be sure you understand what services are covered.