What are Scheduled Benefits?

The term, Scheduled Benefits, refers to a stated and fixed amount we agree to pay per benefit or medical procedure. These amounts can be found in the Schedule of Benefits contained in the policy. This term is often used in a plan referred to as a Scheduled Benefit plan, which is also called a Limited Plan.

Generally, a Scheduled Benefit Plan will not provide as much coverage as a more comprehensive plan and because of this it is generally cheaper. It offers you the option of paying less up front for your coverage and then absorbing more expense later should a medical situation and expense arise.

How Scheduled Benefits work:  You first pay medical expenses until your deductible is met, if you have one (some plans offer a $0 deductible). A specific limit is stated for each type of benefit covered. For example, if the limit for Surgical Treatment is $4,200, that is the most we will pay for any type of surgery related to the same injury or illness.

Claims Example:

  • Deductible:  $50
  • Surgeon Bill:  $8,000
  • Assistant Surgeon bill:  $1,200
  • Scheduled amount for Surgical Treatment:  $4,200 (shown in the Schedule of Benefits in the policy)
  • Scheduled amount for Assistant Surgeon:  $1,000

For this example, we will assume the surgeon’s bill is the first one received, so we will subtract the $50 deductible from this $8,000 bill, which leaves a balance of $7,950. You are responsible for the $50 deductible. We will pay $4,200 (per the schedule) of the $7,950 leftover. You are then responsible for the remaining $3,750.

If we then receive an Assistant Surgeon bill for $1,100, we will review the scheduled benefit for this. It is $1,000. Since your deductible has already been paid, we will pay up to the full amount scheduled, or $1,000. You will pay the remaining $100.

Your total payment:  $50 deductible + $3,750 + $100= $3,900.

Our total payment:  $4,200 + $1,000 = $5,200.

Examples of Scheduled Benefit Plans we offer include:

We also offer a major medical health insurance plan with Scheduled Benefits:  Reside Worldwide

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