Limited Benefit Medical Plans

Limited benefit medical plans are a way to get at least some affordable health insurance protection for you and your family. While certainly not as comprehensive as a standard health insurance policy, they may be the only option for those who cannot obtain, or cannot afford more complete health insurance.

Some states require that such limited benefit plans meet a certain minimum standard for coverage. Limited Benefit medical plans are alternatively referred to as mandate-free, minimum benefit, flexible benefit, and limited benefit plans, among other names. The name of this type of health insurance depends on your state, or the carrier you are purchasing it from.

Benefits offered by Limited benefit medical plans

As the name implies it, this plan offers only a limited number of benefits. Some of the services covered are: doctor visits, preventive care, pharmacy, hospital confinement and surgery.

Most limited benefit plans have been designed so that employers can offer basic medical services to employees and their families.

Benefits can be paid directly to the employee or provider.

Most insurance companies offer some discount for physicians and specialists within the policy.

Usually there are no exclusions regarding preexisting conditions with the exception of pregnancy.

Advantages to Employers of Limited Benefit Plans

These plans can be used with another health plan that does provide coverage for catastrophic advantages.
Limited benefit plans are far less expensive than regular health insurance plans, and still offers basic health care.
The employer is the one that determines eligibility and services covered.

This is a great option for employees who are not able to afford the health insurance offered by regular health insurance plans.

Disadvantages

As mentioned before, there are several limitations within these policies. The most important one is that these types of plan are not designed to fully cover all of your medical necessities. For example, dental and vision care are usually not covered.

Some of these plans are very limited. Before participating in any limited benefits healthcare plan, be sure you fully understand what you are, and are not covered for.

Aspects to consider before purchasing limited benefit health insurance

There are many aspects you should consider before purchasing health insurance. For instance, you should be completely aware of all the services, terms and rules of the policy you are interested in buying.

Always keep in mind that knowing your options is the surest way to find the best health insurance plan for you and your family.

We always recommend working with a broker or agent who will guide you towards the best option for you.

Eligibility

Although limited benefits plans tend to be very non-restrictive, there are certain requirements most health insurance companies ask of employees applying, such as:

  • Employees should work for a minimum of 15 hours per week
  • A minimum of 5 members enrolled in a group is required.
  • Employers are allowed to create a waiting period before which employees are not eligible to enroll in the plan
  • Dependent children under the age of 19 are usually covered by most limited benefits plans