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Limited Benefit Health Care Coverage

Limited Benefit Health Care Coverage

In present economic scenario which is clearly tough, more and more people have started looking for health care solutions. Therefore insurers too have come up with various low-cost options, which however do not provide the complete coverage required.

Blue Cross Blue Shield of Florida recently launched products in a market previously occupied by fringe companies offering discount cards. Though not an insurance, yet the company claims of providing discounts ranging from five to forty percent for card users.

Like several other companies, Blue Cross too, is offering constricted or limited benefit insurance, which covers routine medical care but does not cover fatal problems.

In certain cases, as in the case of Nancy Wittyngham, such coverage is working fine. The lady, based in Weston and a mother of three says that Pro-Medical Plan, a discount-insurance has been doing very well by offering her good doctors. All she needs to do is pay only $136 per month and $10 for each visit to her doctor or the physician for her children, with which she is very happy.

However, the most crucial gap here is that such plans do not cover hospital costs, if a family member falls critically ill.

Even branded discount cards can be troublesome in providing limited benefit. Out of 10 South Florida doctors, who were listed as providers for FamilyBlue Card, only one of them agreed to have accepted the card.

Two of those 10 doctors have never heard of such a card or Coverdell, the company which produces the card.

Ron Weintraub, Benefits Manager, Broward County schools, expresses his belief that there is a distinct customer segment in the market for such discount alternatives, however also says that people need to be completely aware of the fact that these are not full healthcare plans and that they are not paying premiums required for a full plan either.

For example the FamilyBlue Card costs only$20 a month and takes care in providing discounts on doctor visits, vision care, hearing care, diabetic supplies and dental care. The card was launched in September, and was available throughout the state. However presently it is only being marketed to the Miami-Dade people, mostly not insured. About 400 individuals have enrolled so far, says Craig Thomas, Vice-President, Blue Cross.

The website of FamilyBlue advocates sample savings; one can save about $32 on doctors' visit and about $622 on a magnetic resonance imaging. However a brochure of FamilyBlue says that these are examples only and costs may vary.

FamilyBlue even offers to work out a manageable plan to negotiate a settlement of payments in case hospitalization costs over $1500.

FamilyBlue is a product launched by Coverdell, which has a set-up of network that issues discount cards under 75 names. The usage of the card has spread across six million people already says Kathy Lannen, VP, Coverdell.

She also said that the company is focusing at spreading the network throughout South Florida through the FamilyBlue Card. She re-affirmed that the company has always made it very clear that it was not selling insurance through the card and that there is always a 30 day refund guarantee on offer which invites people to at least try it and see how it suits to their requirements.

Florida has a history of trouble with Discount Cards. Between 2003 and 2005 some 1000 odd complaints have been recorded with the state authorities, especially cases wherein people have misunderstood the product to be insurance.


In 2005, the State insisted on having cards to be licensed by the Florida Office of Insurance Regulations, which has been effective in weeding out quite a few problems.

In 2006 and 2007, 51 medical plans were examined and consent orders were issued for 34 such plans. Charges ranging from inflated marketing tactics to inadequate awareness of provider network to the public.

In the past two years, complaints have reduced to two-thirds, with 370 complaints filed only, and these were mostly against entities which were not licensed. 93 cases were against those licensed in Florida. The most common complaints were for getting refunds.

In Florida, some 47 entities are registered to sell discount plans, though Coverdell and some other companies sell under several different labels. CareNet is a card which is sold under a single label, which has been launched by the Community Health of South Florida. Under the plan, against only $25 a month for an individual and $55 for a family of four, primary care in over 20 health centers across Miami-Dade is offered.

Rachel Bennett, of CareNet says, that the focus is primarily on prevention, control on diabetes and hypertension in such a way that events like hospitalization or treatment for diabetic coma can be evaded.

OptumHealth Alles is another card which is issued by a division of the United Health Group (NYSE:UNH). Currently the card has about 15 million members nationwide. Many of them also have complete health coverage also from United Healthcare and the card is only to cover expenses which are not covered under the insurance says Marcee Chmaitt, CE.

OptumHealth is offering a number of discount plans that include pharmacy, vision, behavioral health as well as medical expenses, for individuals in Florida. The card comes at only $29.95.

Over the years of experience, many cards have gradually evolved into modes of providing limited insurance. One such plan is the ProMedical Plan. The plan is based out of Weston with about 25000 members. In a nutshell it offers something can be termed as prepaid health clinic with a discount card.

Accordingly to law, generally a prepaid plan does not cover hospitalization expenses. The plan offers physician visits and basic lab expenses at various locations in Miami-Dade and Broward, in addition to discount cards with expenses for specialist visit, vision care and pharmacy.

Volosin opined that the plan basically works because doctors agree to provide services to a fixed set of members every month.

Going by the complaint history ProMedical has done wonderful recording only a single complaint against it in three years.

Weintraub further said that the ProMedical's offer of having a contract for providing coverage to part-time employees and substitute teachers was declined on grounds of apprehension that it would misunderstood as insurance. However, the plan is being offered to those interested on the web page for employees and there have been no complaints till date.

Florida Health Solutions is another note-worthy plan based in western Miami-Dade. It covers 20000 members in addition to another 10000 who have discount card only. At $40 a month for an individual, one can get basic, limited care from a network of some 1000 health care providers. State records said that the plan has a record of 18 complaints in six years with nine in the current year.


The law has already some limited benefit insurance, through Gov. Charlie Crist has been speaking about his discovery of Cover Florida, a discount health insurance plan which is yet to start.

Some of these plans are offered by the Blue Cross Blue Shield of Florida. Under one such plans a 40 year old non-smoking lady will require to pay $175 a month, with $1000 as deductible, $25 for primary care which is limited to six visits for sickness per year, $750 co-payment for hospital stays, paying 30 percent of charges for some things in return of an annual maximum benefit of $10000.

Marketing for limited-benefit coverage in Florida to employers with many part-time or seasonal workers is being done by Aetna.

The policies are chiefly restricted to a maximum benefit of $10000 per year. In certain cases employers are paying some portion, in some cases they are not. A total of 16700 people have enrolled to the Aetna plans in Florida.

Sandra Foertsch says of an experience wherein she had someone on prepaid plans, who needed to be hospitalized and it was not covered. That is why these plans can be scary. She is an independent agent with South Florida Health Insurance Services. Such things might be suitable for young with good state of health, however products with higher deductibles and affordable are suggested so that at least the person is covered if seriously ill.


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