Here at American Visitor Insurance we field lots of questions from our customers who are looking for insurance particularly for visitors traveling to the US from abroad. One question we often get is: What is the difference between fixed and comprehensive benefit policies? If you use our visitors insurance compare facility on our website, you will see that fixed policies are cheaper (the difference in price increases as the age of the insured increases) than the comprehensive policies. So does it follow that the comprehensive policies are better? Well, not always. Let me give you a run-down of pros and cons of each choice.
Fixed benefit policies are called fixed because they have set caps on each medical expense. For example, they may pay $3,300 for a surgery. If a surgery is required, and it costs $10,000, a fixed benefit policy will only pay what is listed for that benefit, in this case $3,300 (after you have met the deductible). This means that you would have to pay any excess of their fixed amount. Comprehensive policies, on the other hand, do not have individual caps for each medical amount and will pay for a covered medical expense up to the maximum amount chosen (after the deductible and coinsurance are met).
So, are there any pros to the fixed benefit policies? Of course, there are several. Firstly, the price of the premium is much lower due to the lower liability of the insurance companies have since they have limits on what they pay out for each medical expense. Also, they also tend to have lower deductibles (although they are often on a per injury or sickness basis) and they do not care which doctor or hospital you go to. Moreover, they begin to pay their benefits after the deductible for a covered medical expense is met (no coinsurance to pay). With some policies, the maximum coverage is (like the deductible) also on a per injury or sickness basis, which may make you feel more secure in your choice of maximum coverage. One option (Inbound USA) has also added a pre-existing condition rider that will cover a set amount in case of heart attack or stroke, which may be of interest to some of our customers; this option does cost more, but you can decline it.
The cons are that in a more severe illness or accident, they are unlikely to cover all medical costs incurred and it will be difficult, if not impossible, to figure out how much you may have to pay since there is the uncertainty in cost associated with what type of medical attention will be required.
That is where the comprehensive policies can give you more peace of mind. With the comprehensive policies, you can easily figure out what your “worst case scenario” of medical payment will be (just add the deductible to the proportion of the coinsurance amount that you must pay). For example, if you choose a policy with a $250 deductible which has an 80% coinsurance on the next $5,000, then the most you will have to pay is $1,250 since that will satisfy the deductible and your coinsurance amount up to the maximum of the policy. You can then choose a deductible amount and coinsurance with which you are comfortable in the event of an emergency.
So consider your options carefully and feel free to call us if you have any further questions. The only other suggestion I always give my clients who are considering a fixed benefit policy is that choose the highest maximum that you feel you can afford. As the policy maximum increases, so do all the caps on medical expenses. So, for example, at the $50,000 max level, the surgery benefit may be $3,300, but at the $100,000 level, the cap is set at $5,500. In this way, you can still save money on the premium of the policy while having more peace of mind that, should your loved one need to use the visitors insurance, the insurance company will pay a greater portion of the bill.
We at American Visitor Insurance wish you and your visitors happy and healthy voyages wherever their travels may take you!