What is a Base Plus Plan?

You might have come across a health insurance policy called base plus plan recently or you met an insurance agent who offered it to you. You’re curious as to what kind of health insurance policy this is, how it works exactly, and if this kind of policy is standard across all insurance companies. If this is so, then you are reading the right article as this will attempt to explain the base plus plan policy in a comprehensive manner.

What is a base plus plan policy exactly? A base plus plan is a type of health insurance plan that has two-parts, hence the name base plus. Although there are no standard terms observed across all insurance companies that offer this type of policy, this is the basic set up of a typical base plus plan. One part of the base plus plan is for basic medical coverage and the second part is for major medical coverage.

The basic medical coverage of the policy essentially covers all basic medical needs of the insured person. These needs include doctor visits, hospitalizations, prescriptions, diagnostic exams (i.e. x-rays, blood work, etc.), and other simple medical procedures which is directly paid by the insurance company who sold the policy. The coverage is not completely infinite and a maximum limit for the frequency of physician visits, hospital confinement days, and undergoing a particular medical procedure is set by the insurance company policy terms. The limit varies from company to company and is subject to the insurance company selling the policy. Once the limit of the basic medical coverage of the base plus plan insurance is reached, the excess is carried over to the major medical coverage part of the plan. Understand that the major medical coverage part of the plan will not be directly paid by the insurance company.

The major medical coverage part of the policy covers for medical procedures that the policy sold by the company considers beyond basic medical need. These may include specialized treatments, surgeries, and medical expenses that exceeded the basic medical coverage limit of the insured’s policy. In common practice, there is no usual limit set for this part of the coverage. However, unlike the basic coverage which requires no fees from the insured person as it is already covered by the company, this part of the policy requires a non-reimbursable co-payment to be paid when the service is rendered. Apart from this, a yearly deductible is asked of the policyholder before the insurance company provides any kind if medical coverage.

If you are set to purchase this type of insurance policy, ask your agent all the details about the policy including the limits set by the insurance company where you plan to buy. Know what is considered part of the basic medical coverage and how the deductibles for that particular company are charged.

This type of insurance policy is on the whole most cost-effective for healthy people because basic medical needs are completely covered. Know the other types of health insurance offered first before deciding on your purchase.