Major medical plans are like rock stars of the health insurance world because they make people happy by providing health insurance coverage for the widest variety of people and for the widest variety of conditions. Group health major medical plans, then, are the lead singers in the band. With a group health policy of health insurance, everyone wins. The employees get great coverage at a low cost and everyone is entitled to coverage. The health insurance company is happy because it collects premiums for all of the people in the group, but only pays out significant amounts for a relative few of those people.
Major medical plans can be comprehensive or supplemental. Comprehensive plans are intended to cover most of not all of the person’s medical claims once a deductible is met. Supplemental plans are intended to do just that. They supplement a person’s regular insurance policy and cover anything that the regular policy fails to cover. Each type of health insurance coverage will have a deductible. Some deductibles are intentionally set a zero, and that lucky person does not have to pay any money before coverage becomes available to him. Some insurance policies, however, do have a set dollar amount that must be paid each year before the insurance policy pays any health claims.
A group major medical plan might also fall into one of several categories. One such category is the Health Management Organization, or HMO. With an HMO, the insured is more limited in the types of doctors he can see. It is a low cost alternative, but if you need to see a specialist, you will need to get a referral from your primary care provider in order to see the specialist. Another category is the Preferred Physician Organization, or PPO. With a PPO, you have more freedom to choose health care providers (including specialists) without a referral. However, you must choose a provider within the list of preferred providers or else it will cost more to see the doctor. There are also other categories of plans that are a combination or variation on the above organization formats.
Major medical plans cover pay for most hospitalizations, drugs, medical treatments, diagnostic tests, oxygen and other treatments. Even though the major medical plan is a rock star, it does not cover things such as cosmetic surgery or dermatological treatments such as facial peels. Before you make an appointment for such a treatment, you should consult the exclusions portion of your health insurance policy.