Health insurance is designed to protect against loss of income and expenses for medical care. There are two broad categories of health insurance policies: disability income policies and medical expense policies.
Disability income policies can also be referred to as loss of income, loss of time or replacement income. This type of policy will pay benefits to an insured who is disabled and can no longer work to earn a regular income. Payments can be weekly or monthly depending on the policy.
Medical expense policies are represented by a wide range of coverage from very minimal to comprehensive packages with multiple coverage. Some include both accidents and illnesses, various hospital expenses and other costs pertaining to medical care such as accident and sickness policies, hospital-stay policies, basic medical expense policies and major medical expense policies.
Any of these policies might cover various combinations of the above and may be paid in a lump sum.Some policies cover only accidents and not illness. As you might imagine, policies like this are very specific about what is considered an accident.
It is important to understand what is defined as an accident as it pertains to the health insurance industry: an accident is an event that is unforeseen and unintended.
Keep in mind that any discussion of this type of policy also applies to any type of policy that includes accidental coverage, not just accident specific policies.
Accident benefits are most commonly paid for accidental loss of life (also called accidental death), accidental loss of limb or sight (dismemberment), loss of time and/or income, hospital expenses, surgical expenses, and medical expenses like visits to the doctor.
Accidental death benefit can also be referred to as “principal sum.” This type of coverage should not be confused with life insurance. There is a world of difference between the two. Life insurance policies will generally be paid regardless of the cause of death. An accidental benefit is paid ONLY if the death is accidental as opposed to a death by natural causes or illness.
The person who receives the death benefit is called the beneficiary. The policy owner has the right and responsibility of naming beneficiaries. Usually there is a primary beneficiary however he/she can assign a second and even a third beneficiary.
The primary beneficiary is the first person in line to receive the benefit in the event of the death of the policy holder. The policy owner can also name a second beneficiary who would receive the benefit in the event the primary beneficiary dies before the insured. Some policies can include a third beneficiary who would be in line after the first two.
There is another important element in regard to accident policies: An accidental death may not be instant. A person can die as a result of an accidental injury months after the accident occurrence. Read your policy carefully because most stipulate that the accidental death benefit will only be paid if death occurs within three months of the accident.