Supplemental insurance for scheduled medical procedure

January 1, 2010

Q: I currently have health insurance. I was recently told that I have to have a procedure done next week. If I sign up for supplemental health coverage now, will I be covered? And if so, how will my coverage be applied? Will the plan kick in after the deductible on my other plan is met?

A: Supplemental health insurance is paid as an "up front" cash benefit, prior to any deductible being applied by other insurance. That enhancement effect is the primary distinction of this type of insurance as compared with regular major medical insurance. It is intended to enhance or "add to" the benefits paid by other insurance.

The primary issues of concern for your particular situation are 1) starting date of coverage and 2) treatment of pre-existing medical conditions. The answers are different for each brand of supplemental insurance. For example, Basic Health Insurance always starts on the 1st of the month following application processing and excludes coverage for pre-existing medical conditions for six months. Core Health Insurance, in contrast, may be started at any time and covers pre-existing medical conditions except for illnesses and hospitalization benefits - from the starting date of the policy. Each supplemental insurance plan gives more detail about start date and provisions for pre-existing conditions on its enrollment Web page.

Keep in mind that regardless of the choice of supplemental insurance, the value of such coverage is in benefits over the long term, not for one immediate medical procedure. No insurance plan is designed to pay out more than the cost of the premium for expected known costs over the short term; obviously the insurance plan would go broke.

The bottom line is that supplemental health insurance may cover bits and pieces of your immediate expenses in coming weeks, this is not a good way to evaluate the decision to purchase supplemental health insurance.

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