Fixed Benefits Plan (Scheduled Benefits Plan)
These policies are characterized by various benefit limits for each type of covered medical expense. These benefit limits typically are not the same as the policy maximum.
For example, a policy with a $50,000 maximum limit may feature upto a maximum of $2000 for surgery, upto a maximum of $500 for diagnostic services (X-rays, scans) etc. The maximum amounts for different situations are detailed in the policy brochure.
Typically you are required to pay an initial deductible for each injury or sickness and then the plan pays for the rest of the covered expenses.
Scheduled Benefits Plans have the lowest premiums, but the consumer must be aware that the benefits offered are relatively limited as compared to the Comprehensive Coverage Plans.
Example of Scheduled Coverage Plans include ‘Visitors Care’ underwritten by Sirius International.
Comprehensive Coverage Plan
These policies typically do not have benefit limits based on the type of medical expense. Usually benefits for covered medical expenses go all the way upto the policy maximum (less deductible and co-insurance).
Typically for all covered medical expenses during the policy period the insured pays the deductible plus 20% of the first $5,000; and then the plan pays 100% of the eligible medical expenses upto the policy maximum.
The details for each policy such as the policy maximum, medical expense eligibility etc. are listed in the policy brochure.
Comprehensive Coverage Plans have relatively higher premiums, but in turn offer better benefits than the Scheduled Benefits Plans.
Examples of Comprehensive coverage plans include ‘Diplomat America’, ‘Atlas America’, and ‘Patriot America’.