What types of expenditures are commonly excluded under major medical plans?
Under traditional major medical plans the following are a few of the typical exclusions: 48366. charges which would not be made in the absence of insurance 48367. charges for services that are considered experimental or investigational 48368. charges which exceed reasonable and customary levels 48369. charges for services and supplies that are not deemed medically necessary 48370. charges for custodial care Q: What is the difference between coinsurance and co-payment? A: Coinsurance refers to cost share. For example, after the calendar year deductible has been paid under a major medical plan, the company and the insured share payment of a specific dollar amount of expenses, say $5,000. If the coinsurance is 80/20%, the company agrees to pay 80% and the insured agrees to pay 20%. In the case of the aforementioned $5,000 the insurance company would pay $4,000 (80% of $5,000 ) and the insured could pay $1,000 ( 20% of $5,000 ). Co-payment, on the other hand, refers to the small up front c
