November 30, 2007, Newsletter Issue #104: Beware Of The Cap

Tip of the Week

Some insurance plans have a "cap," which may be the most you will have to pay for medical bills in any one year. You reach the cap when your out-of-pocket expenses (for your deductible and your coinsurance) total a certain amount. It may be as low as $1,000 or as high as $10,000. Then the insurance company pays the full amount in excess of the cap for the items your policy says it will cover, but there are limits. The cap doesn’t include what you pay for your monthly premium. It may also have a cap or limit on medical tests, number of doctors visits, preventative coverage and other services. Inquire as to what types of healthcare the cap will cover. For example, some policies will pay no more that $550 a day for hospital care and for a certain amount of days. Some insurance will impose a “lifetime maximum cap” which is the amount after which the insurance company won't pay anymore. This is important to know if you or someone in your family has an illness that requires expensive treatments.

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