FAQ

Q: What is a base plus plan?

A: A base plus plan is a two-part heath insurance plan. Basic medical coverage – (for such expenses as hospitalization, surgery, physician’s visits, diagnostic laboratory tests and x-rays) is provided under the first part. There may be limits on these expenses, such as a limited number of hospital days and a surgical schedule, but no deductible or coinsurance applies to the covered expenses. The employee is reimbursed starting with the first dollar of expenses.

The second, or major medical, part of the plan covers other heath expenses. The coverage is broad, with fewer limits; however, a deductible is required before the employee is reimbursed for expenses.

Q: What are the advantages to a base plus plan?

A: From the employee’s point of view, base plus plans appear to provide more generous benefits because of the lack of deductibles and coinsurance in the basic medical part.

Q: What is a comprehensive plan and it’s advantages?

A: A comprehensive plan provides coverage for most medical services using one reimbursement formula. In a pure comprehensive plan, a deductible must be met before reimbursement for any covered expenses begins, and coinsurance applies to all covered expenses until the maximum employee out-of- pocket expenses limit is reached. Additional covered expenses are paid in full.

Because employees share from the beginning in the cost of their medical expenses when they are incurred, a comprehensive plan encourages them to use more cost-effective health care. The patient is more likely to be cost-conscious and to seek out more cost-effective health care services and providers.