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Thread: please define: Comprehensive Major Medical Insurance

  1. #1
    Senior Member qbquilts's Avatar
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    Either I or my co-worker are confused about our insurance at work. Can someone who works (worked) in insurance or in the benefits department of HR please explain what Comprehensive Major Medical is?

    Thanks so much!

  2. #2
    Moderator QuiltnNan's Avatar
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    your company should have a benefits administrator to explain your benefits to you. if not, your insurance carrier could explain what is covered under that term.

  3. #3
    Super Member Glassquilt's Avatar
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    I'm interested in this

  4. #4
    Super Member Rose L's Avatar
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    Every carrier is different but generally it means that you have some catastrophic coverage for things like cancer, transplants and HIV/Aids etc. Usually there are exclusions which your employer sets in place and usually your policy is limited to a specific dollar amount of coverage at which time you are no longer able to be covered (policy limit). Read your benefit package or check with your HR department for specific clarification. I used to work for Blue Cross and Blue Shield and later I became a Certified Professional Medical Coder. That was back in the good days before I became disabled. Hope this helps.

  5. #5
    Super Member bluteddi's Avatar
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    I am retired health care worker.. but I swear, they try to make it as complicated as possible just so ppl WONT understand it!!!!.... your not alone in this confusion

  6. #6
    Senior Member qbquilts's Avatar
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    Quote Originally Posted by Rose L
    Every carrier is different but generally it means that you have some catastrophic coverage for things like cancer, transplants and HIV/Aids etc. Usually there are exclusions which your employer sets in place and usually your policy is limited to a specific dollar amount of coverage at which time you are no longer able to be covered (policy limit). Read your benefit package or check with your HR department for specific clarification. I used to work for Blue Cross and Blue Shield and later I became a Certified Professional Medical Coder. That was back in the good days before I became disabled. Hope this helps.
    So generally speaking, what kind of plan is health insurance that includes copays for doctor visits, coinsurance for non-copay items (with a zero to manageable deductible - not a high deductible plan), and a high enough lifetime max that most cancer/transplant stuff should be covered. Does "comprehensive major medical" not include basic doctor visits? (generally speaking, of course)

  7. #7
    Super Member LovingIzabella's Avatar
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    Comprehensive Major Medical is generally as follows:
    A plan of insurance with a low deductible, high maximum benefits and a coinsurance feature. It is a combination of basic coverage and major medical coverage which has virtually replaced separate hospital, surgical and medical policies with each having its own deductible requirements.
    It does include basic doctor visits (or it should)
    Hope this helps
    Hugs
    April

  8. #8
    Super Member ThayerRags's Avatar
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    Comprehensive Major Medical Insurance = Only the Insurance Company can Comprehend what it actually covers, and even then, sometimes a Judge has to help them figure it out.

    CD in Oklahoma

  9. #9
    Super Member Murphy's Avatar
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    If you google it, you get some very good websites which help define this term and what it means in depth. Your company's HR office should also be able to assist. Good luck (smile).

  10. #10
    Super Member QandE2010's Avatar
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    COMPREHENSIVE MAJOR MEDICAL: A type of medical insurance developed to meet the need for protection against a broad range of catastrophic medical expenses, whether incurred in or out of the hospital. The major medical expense benefit usually is subject to a deductible.
    HOWEVER, that being said, each insurance carrier has a different explanation for what exactly is covered under Major medical. (Full disclosure: I am a benefits consultant and work with various insurance carriers.) As I mentioned, each carrier's definition is different. So the best place to find out exactly what is covered under your plan is to go to your benefits booklet or contract.
    Hope this helps.

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