THE HEALTH INSURANCE: HELPFUL HINTS

The subject of health care costs is one of the most controversial topics in the country today. The Reagan administration, concerned by the sky-rocketing cost of health care, has proposed a combination of tax increases and limits on payments for services. All sorts of recommendations have been advocated by ahost of conscientious citizens and politicians.The medical surcharge is just one such proposal. Under this plan, a recipient of medical benefits from the government would be expected to reimburse the government according to his ability as determined by the amount of income tax he paid in a given year. The obligation to repay medical benefits would carry over from one year to another. If you received help when "down on your luck" when things got better (asevidenced by your income tax returns) your would be expected to pay off what would be considered to be a debt to the government. If you remain poor enough to pay no income tax you would never be expected to reimburse the government.

A Presidential Commission on the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, issued a report in the spring of 1983 entitled, "Securing Access to Health Care." They found 22 million to 25 million Americans had no health insurance coverage and that because of jobchanges or other reasons, approximately 34 million were without coverage at some point during a one year period. So it's time to find out what risk to be insured for.

BASIC MEDICAL COVERAGE

Basic coverage provides for hospital expenses, surgical proceedings and may be written to cover some health services outside the confines of the hospital. It was your common, and as the name implies, "basic coverage" for medical expenses until costs in the health field began to soar dramatically after the secondworld war.

Because the maximum benefits are low and many expenses may not be covered. Major medical policies have high or even unlimited maximum benefits which can be applied on a various time oriented base. Most types of medical care expenses are covered up to the policy's limits. However, major medical policies have what are called "inside limits' restricting coverage for certain items such as room and board, surgery and private nursing, to a specific pre-determined amount and no more. That amount is the "inside limit" for that particular policy.

Because of the high maximum coverage these policies provide, the premiums would be out of reach for most people if deductibles and coinsurance provisions were not used. policies vary but the consumer is usually required to pay the first $100 or $200 of medical expenses (deductible) on either a calendar or benefit-year basis (the name is self-explanatory) or a per cause basis.

Per cause means incident by incident. After the deductible is paid, the coinsurance provision normally provides for the insured to pay a specified portion of the covered expenses. An 80/20 coinsurance provision would require the insurance company to pay 80% of those items covered under a particular policy (N.B. not 80% of the entire bill) and the insured to be responsible for the remaining 20%.

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