Fixed Vs Comprehensive Coverage
If you have been researching or shopping for health insurance for foreign visitors to the USA, known as visitors insurance, or visitors coverage for your parents or yourself, you may have seen some different terms you are unfamiliar with. You might be wondering what the difference is between limited coverage (fixed coverage) vs. comprehensive coverage visitors insurance. This article can hopefully help clarify those terms.All visitors insurance plans fall into essentially two major categories:
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Fixed Coverage Plans:
Cheaper, limited coverage
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Comprehensive Coverage Plans:
More cost, better coverage
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Fixed coverage plans are also called Scheduled Benefit plans. They provide limited coverage compared to comprehensive plans and are insufficient in most cases. Therefore, we always recommend comprehensive plans to everyone.
Comparing Visitor Insurance Plan Types
| Feature | Fixed Coverage Plans | Comprehensive Coverage Plans - Recommended |
|---|---|---|
| Benefits | After you pay the deductible, the plan pays a set maximum amount for every procedure such as $55 for doctor's office visit, $330 for emergency room visit, $3,300 for surgery and so forth. | After you pay the deductible, the plan generally pays a set percentage level up to a certain amount then 100% up to the chosen policy maximum. E.g., after you pay the $250 deductible, the plan pays 80% for the first $5,000 in eligible expenses, and then 100% up to $50,000 policy maximum. The exact configuration varies based on the plan. |
| Cost | Even though prices for fixed coverage plans are attractive, you should really understand what you are purchasing so that it will meet your expectations if you need to use it. | You get much higher benefits that are sufficient in regard to the high healthcare costs in the U.S. |
| Deductible | Deductible can be either once per sickness/accident or once per period of coverage. | Deductible is typically for the entire duration of the purchase, maximum once per year. |
| Out of Pocket Maximum | You have unlimited out of pocket expenses as the providers are free to charge anything they like, including for emergency medical services. | As you get a percentage-based coverage, your out-of-pocket maximum is typically the deductible, applicable coinsurance, and sometimes a small additional amount; also, when the expenses are more than the chosen policy maximum. |
| Policy Maximum | The policy maximum such as $50,000 or $100,000 you see is the overall aggregate limit for the total of all the scheduled benefits, and it does not mean that all your medical expenses will be completely paid up to the policy maximum. | You are guaranteed coverage up to the policy maximum for all eligible expenses with a comprehensive coverage plan. |
| PPO Network | Most plans do not participate in a PPO network. They are called indemnity plans. It is up to the provider whether to bill the insurance company directly or not, meaning you may have to pay up front and wait for reimbursement. | Most plans are PPO plans. That means that the insurance company has contracted with providers all across the United States who participate in the PPO network, accept the insurance card, bill the insurance company directly in most cases and charge you network-negotiated fees which are typically lower than their regular fees. |
| Contracted Rates | The plans that do not participate in any PPO network do not have any contracted rates (or network negotiated rates or discounted rates). You will be billed for their regular rates. | The plans that participate in PPO network provide contracted rates for services obtained within the provider network. |
| Providers | You can visit any doctor or hospital you'd like. You get a health insurance card that has all the information that the provider may need to bill the insurance company directly. Therefore, most providers would do so. However, in case a particular provider declines to do so, you would first need to pay up front and file for reimbursement. | You can visit any provider you like in comprehensive coverage plans as well. However, visiting the providers within the PPO network is beneficial as you will receive the network negotiated fees. Also, depending on the chosen plan, if you obtain services outside of the network, the plan may pay a slightly lower percentage. |
| Travel Coverage | Travel related benefits such as loss of checked luggage, trip interruption, emergency reunion and return of minor child(ren) are not provided. | Typically provides travel related benefits such as loss of checked luggage, trip interruption, emergency reunion, return of minor child(ren), hazardous sports coverage (optional or standard), terrorism (optional or standard) etc. |
| Acute Onset of Pre-Existing Conditions | Many plans provide coverage for acute onset of pre-existing conditions. However, it will pay according to the schedule of benefits, like how it would pay for new medical conditions. | Many plans provide coverage for acute onset of pre-existing conditions. Just like coverage for new medical conditions, it will be subject to deductible and coinsurance. The exact coverage limit will vary by the specific plan. |
The Risks of Purchasing Fixed Coverage Plans
Please make sure to read the brochure, certificate wording and other relevant information about the plan you are considering purchasing. If you have any questions, please feel free to contact us at any time. Whatever plan you finally purchase, please make sure that you make an informed decision. A lot of very well laid out, clearly mentioned and comprehensive information is available on this web site. Please make sure to read and understand what you are buying.
In any case, the insurance company will pay claims according to the terms and conditions of the insurance plan you purchased. Under no circumstances will the insurance company pay more for a benefit than the scheduled benefit amount for that particular expense. So, be sure to read the terms and conditions of any visitor insurance plan prior to purchase, no matter if it is fixed coverage or comprehensive coverage.
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