Comprehensive or Standard (Fixed) Coverage Plan??

India Network offers two plans to its members to choose from – a) Standard plan (with or without Pre-existing Coverage option); and b) Comprehensive Plan (with or without pre-existing option).  One of our goals at India Network is to do the homework for thus making it easy to pick the best plan. Recently a physician member called our office to help decide which plan is best for visiting parents. The doctor could not make up his mind as both plans have very attractive but distinct features and unfortunately purchasing both plans for the same duration and for the same visitor is not allowed.  It is not easy to choose one; however, major differences between the plans are outlined below. We hope it makes it a bit easier to pick the right one for your visitors.

Standard Plans – Lower premiums for visitors 60 years and older, open to go to any provider or facility, pay well beyond the typical medicare payments that providers get from federal government for services, and offers a maximum of $60,000 for pre-existing condition related issues. You first meet your deductible, then the plans pay as given in schedule of benefits (caps for various procedures). If the provider charges more than allowed amount, you are typically responsible for payments for the difference.

Comprehensive Plans – Typically higher premiums for visitors 60 years and older, network based benefits, after meeting deductible, the plan pays 80% of covered expenses up to $5,000 and 100% of covered medical bills after that till policy maximum, pre-existing coverage offered is only $20,000 (highest offered by any plan in the United States for this kind of program). Since providers are in the network, you do not need to worry about excessive billing.

The major difference is that in Standard Plans, the insurance company does not use network and pay a pre-defined benefit either to Hospital or to policy holder. If the billed amount is below the defined benefit, then you are covered 100 percent.. but if it is short, then you are responsible for the difference. . thus exposing your liability for excessive billing by providers.

Which one to choose particularly people with pre-existing conditions such as Diabetes, Blood Pressure etc.?

Depending on your own philosophy of risk taking, you have to make your own decision. In seeing many cases, we find India Network Standard Plan with $150,000 policy maximum with $60,000 pre-existing condition would serve best for many and the reimbursements from $150,000 policy maximum plan are extremely high compared to average PPO plan payments.

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