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Hospital Indemnity Insurance in Texas

In Texas, hospital indemnity insurance or hospital confinement indemnity is a supplemental insurance coverage that pays a daily cash benefit when the insured is admitted and confined to the hospital.

Hospital indemnity insurance complements your traditional health coverage to help you settle in-patient or ICU bills which can be quite expensive and mostly unexpected. For what it is worth, medical insurance usually covers hospital bills but may not fully cover the fees associated with hospital stay such as room and board fees. This is where hospital indemnity insurance comes in.

To determine if getting hospital indemnity insurance makes financial sense, consider your current age, health status, and depth of your medical insurance coverage. Do not dive in without fully understanding what hospital indemnity insurance, its coverage limits, and exclusions.

What is the Purpose of Hospital Indemnity Insurance?

Hospital indemnity insurance aims to complement primary health insurance plans by ensuring that the costs associated with being admitted to a hospital are duly catered for. They are not considered substitutes to actual health and accident insurance but serve as vital add-ons to traditional policies. You can purchase this policy to get partially or fully reimbursed for direct or out-of-pocket payments made when having one or more overnight hospital stays. These hospital indemnity insurance policies typically pay pre-agreed cash amounts for each day of hospital stay and place no restrictions on your spending preferences. Typical out-of-pocket expenses that may result from planned or unexpected hospitalizations include copayments, deductibles, drug prescriptions, and rehabilitation bills, along with sundry non-covered costs. You can also choose to spend the cash received on personal needs such as groceries, rent, or utilities. Note, however, that insurance companies can refuse to cover you if they confirm you have a pre-existing condition in the state of Texas. This is because Hospital Indemnity insurance is not subject to the Affordable Care Act (ACA).

Note, however, that since a broad range of insurance solutions are available in Texas, Short-term plans are frequently purchased to supplement Hospital indemnity insurance. This provides more insurance coverage and mitigates a common drawback associated with Short-term plans such as non-guaranteed renewals.

What are the Types of Hospital Indemnity Insurance?

Generally, Hospital Indemnity insurance in Texas is broadly classified into individual indemnity insurance and group indemnity insurance. Depending on the insurer, however, a variety of Hospital indemnity plans may be further differentiated based on:

  • The insured’s age
  • The health insurance type of the insured
  • The insured’s preferences and selections

Nevertheless, the overarching principle remains the same: paying cash to insureds for non-covered expenses for hospital stays. In addition, hospital indemnity plans also exist for:

  • Residents under the age of 65 and enrolled on their employers’ plans or ACA plans.
  • Residents above 65 and enrolled on Medical Advantage plans

These types of hospital indemnity insurance vary based on the insurance company involved. Contact a licensed Texas health insurance agent to obtain detailed information and additional clarity on the characteristics of different supplemental plans that may fit your set of circumstances. Furthermore, seeking the services of these state or local licensed insurance agents comes at no cost, offers a broader range of options and features, and eases your decision-making process.

Do You Need Hospital Indemnity Insurance?

Certainly. You can use hospital indemnity insurance to ease the financial strain and mental distress that is often associated with paying high medical bills for unexpected hospitalizations. This is true since your primary medical insurance rarely settles all your healthcare expenses, especially those associated with deductibles, copayments, and coinsurance.

Hospital indemnity coverage is an especially crucial supplemental option for non-ACA health plans (example: Short-Term health insurance).

You may need this supplemental coverage to help replace some or all of your income lost when illness-related absences occur at work.

Why Do You Need Hospital Indemnity Insurance?

Hospital indemnity insurance is useful for many reasons, the chief of which is the financial hedge it offers the insured. It is a widely-accepted fact that hospital admission costs can easily exceed the annual deductibles of most base health insurance plans especially when such stays are extended. Also, depending on your specific health insurance coverage, certain medical expenses may not be covered. In some other instances, they may be limited by the duration of the hospital stay. You can, however, use the daily payouts from your hospital indemnity insurance to address these cost gaps and conveniently accommodate other unexpected medical bills that may arise.

It also helps you to preserve your savings since it supplements the coverage that other major insurance plans provide. Both planned and unplanned hospital stays can lead to unmanageable medical debts and in extreme cases, contribute to bankruptcies. However, by purchasing a Hospital indemnity plan, you can ease the financial strain of paying a deductible and mop up other out-of-pocket bills emanating from hospital stays.

Furthermore, you can avert the financial stress caused by the attendant loss of income that often results from illness-related absences and hospitalizations. Hospital indemnity coverage can serve as an important income cushion by substituting as a source of daily income and providing a small allowance for each day spent in hospital confinement.

These supplemental plans are additionally helpful in reducing the mental stress associated with worrying whether your regular health coverage will sufficiently meet your medical needs. Regardless of the existence of any emergency savings, this uncertainty remains a constant source of worry for many policyholders in Texas, particularly for those with non-ACA high deductible plans and no supplementary health coverage.

How Much Hospital Indemnity Insurance Do You Need?

In Texas, this amount is determined by the specific daily benefit you need and the premium associated with this benefit. To this extent, a wide assortment of Hospital indemnity plans are available to match various coverage needs and address your specific situation. Generally, indemnity plans can cover:

  • Hospital admission (with the option of surgery)
  • Critical Care Unit (CCU) admission
  • Intensive Care Unit (ICU) admission

But, other plans can cover one or more of the following additional services:

  • Ambulances
  • Continuous care
  • Emergency rooms
  • Physician office visits
  • Outpatient surgery
  • Diagnostic imaging procedures (for outpatients)
  • X-rays and laboratory procedures (for outpatients)

The monthly cost or premium for Hospital indemnity coverage generally varies with your specific coverage needs. Generally, high-premium plans offer a broader range of benefits in comparison to low-premium plans which provide a narrower spectrum of benefits. Other factors affecting the cost of supplemental insurance you may need include the:

  • Applicant’s age
  • Applicant’s gender
  • Applicant’s tobacco use

However, because coverage needs vary widely from person to person, it is best for you to seek out a licensed professional insurance agent in Texas. In addition to getting answers to all your queries, a local agent can also provide you with the best quotes available in your area and help secure the most suitable combinations of policy features that match your preferences.

What Hospital Indemnity Insurance Coverage Do You Need?

The specific type of Hospital indemnity coverage you opt for generally depends on your specific need. It is also affected by the amount of out-of-pocket expenses you wish to cover for unplanned medical care during hospital stays. Generally, to get higher daily payouts for hospital admissions, you must be prepared to part with higher monthly premiums. The reverse also holds for smaller daily payouts. Since a huge proportion of Texans face financial difficulties when settling unplanned medical bills from their savings, Hospital indemnity insurance provides an affordable solution when these events occur.

However, to obtain the best hospital indemnity insurance coverages, reach out to a licensed Texas health insurance agent. Beyond the broad outlines and features of this supplemental insurance, a Texas licensed agent is professionally trained to help interested residents get coverage individually tailored to their specific preferences and situations.

Is Hospital Indemnity Insurance Required by Law?

In Texas, Hospital Indemnity insurance is not mandated by law because it is not a comprehensive health insurance policy but a complement to regular health coverages. It can, however, be purchased as a standalone coverage to specifically provide alternative income especially for being absent from work due to unexpected hospital admission. The Texas Administrative Code, however, stipulates a period of confinement or admission along with minimum cash benefits payable per day of hospital stay. Per state law, this minimum period of confinement or admission is 31 days while the minimum daily benefit is $15.

How Does Hospital Indemnity Insurance Work?

Hospital indemnity insurance becomes effective once you (the insured), your spouse, or any of your children/dependents visit the hospital and become confined there for further examination and/or treatment. Other events that may trigger the payment of daily cash amounts include confinement in a Critical Care Unit (CCU) or an Intensive Care Unit (ICU) for a covered health issue. The amount is paid in addition to any other coverage you may already have and it varies with the specific indemnity plan you have purchased.

What Does Hospital Indemnity Insurance Cover?

All hospital confinements are generally covered by Hospital Indemnity Insurance including hospital stays associated with ICU and CCU in Texas. More specifically, this supplemental plan depending on the insurer may also cover the following healthcare areas:

  • Surgery for outpatients
  • Ambulance services
  • Long-term care
  • Doctor visits
  • Diagnostic imaging procedures for outpatients
  • Emergency room services
  • Laboratory and x-ray procedures for outpatients.

What is Hospital Indemnity Insurance Good for?

Hospital indemnity insurance is very good for handling unexpected medical expenses and providing financial protection for your life, property, and health. It also protects the following:

Health: For example, a young couple expecting their first baby are expectedly excited about the approaching delivery. However, their happiness can be dulled by the prospect of additional expenses if they fall into the 32% pool of Americans who deliver via a cesarean. Worse still, their bills can further surge in the event their newborn needs to be confined in the hospital for the treatment of, for example, neonatal jaundice. With Texas delivery costs averaging between $9,000 to $17,000, most primary medical insurance will likely cover up to 80% of this cost. Fortunately, hospital indemnity coverage can help this couple close the expense gap and restore their joy of having a new baby.

For more details on the benefits of this coverage, consult a Texas-licensed health insurance agent. Regulated by the Texas Department of Insurance (TDI), they sell a variety of insurance policies and can assist you to steer through the different indemnity plans and select the most beneficial coverage matched to your needs.

What Does Hospital Indemnity Insurance Typically Include?

Hospital indemnity insurance typically includes coverage for hospital admissions, confinement in intensive care units and critical care units. Beyond these general coverage areas, discuss your needs with a Texas-licensed agent to gain insights into the different aspects and benefits of supplementary indemnity insurance.

Who Can Get Hospital Indemnity Insurance?

Hospital indemnity insurance is open to individuals and members of groups who can pay the monthly premiums required and satisfy other eligibility requirements provided by their chosen insurance company. The general requirements are similar to those of major insurance policies which include the applicant’s age, sex, and tobacco use. Applicants must also be between the ages of 18 years and 65 years to qualify and must enroll within the legal enrollment period. In addition, this supplemental insurance is ideal for anyone with a:

  • Young family
  • History of paying medical bills
  • Desire to maintain low out-of-pockets payments

You should also get Hospital indemnity insurance if you are likely to experience the following:

  • A long-standing health problem that could be admitted for such as diabetes or heart disease.
  • A pregnancy with the chances of staying in the hospital for additional days
  • A surgery requiring either an overnight stay or extra admission days to recuperate
  • A major insurance plan with a high-deductible
  • An Affordable Care Act (ACA) plan with a small, restricted network and long commute hours to access care.
  • A Short-term health insurance plan with high deductibles and low coverages.

Nevertheless, securing the services of a Texas licensed insurance agent remains a surefire way to obtaining the best supplemental plan. These state-licensed agents usually charge no fee for their services and have strong affiliations with a variety of insurers. This makes it easy for them to advise you on the best combination of benefits and features based on your specific tastes.

What are the Benefits of Hospital Indemnity Insurance?

Unlike typical major medical insurance plans, hospital indemnity insurance is cheaper to purchase and offers more flexible options for covered illnesses. With increasing healthcare costs, even traditional (ACA-complaint) insurance coverage rarely covers extended hospital admissions. Non-ACA compliant plans (like Short-Term insurance) usually cover even less.

A recent official estimate puts the average cost for a typical 3-day hospital stay at $30,000 while treatment for a fractured lower limb can run up to $7,500 bill. On top of these, the insured is still required to pay annual deductibles and other costs such as coinsurance and copays before their coverage can be activated. Other benefits that make hospital indemnity insurance attractive to numerous policyholders in Texas include:

  • Cash benefits are paid directly to the insured to use as they choose.
  • No network limitations make it possible for the insured to access care from any doctor or medical facility in any location
  • A simple claim process that facilitates cash payouts within 10 days
  • Portability of coverage enables an insured to enjoy benefits even when they switch employers.
  • Easy inclusion of family members within this supplemental plan.

Nonetheless, Hospital indemnity insurance is not without any drawbacks. One major disadvantage of this coverage is that it is not subject to health care regulations such as the ACA. As a consequence, certain insurers may refuse to provide coverage if they establish that pre-existing conditions exist. To get better acquainted with additional advantages and demerits of a Hospital indemnity coverage, talk to a state-licensed insurance agent. Certified by undergoing a rigorous licensing course, Texas health insurance agents can provide vital hospital indemnity insurance-related information and address other queries.

Is Hospital Indemnity Insurance Worth it?

Hospital indemnity insurance is worth purchasing simply because it helps to close the cost gap not covered by regular health insurance plans. Persons without this supplemental coverage are often faced with heavy medical bills due to increasing deductible, copay, and coinsurance costs. Other additional costs such as those associated with health services that fall outside specified healthcare coverage and out-of-network care also make getting this supplemental plan worth it. These increasing out-of-pocket costs that must be paid by the insured before their insurer will settle their claims can be easily offset by selecting a suitable hospital indemnity plan.

Hospital indemnity is especially worth it, if purchased as a supplement to short-term health insurance.

Furthermore, the convenience of this supplemental coverage in easing payout claims, receiving direct cash benefits, portability, and zero restriction on cash benefit use makes it an invaluable insurance solution.

Your Hospital indemnity insurance lapses when you fail to pay your monthly premiums, therefore, causing your insurer to terminate your coverage. This termination results in the loss of your benefits and often occurs if you still fail to make any premium payment within a statutory grace period (Sec. 1201.209). This loss coverage also implies that you lose the benefit of being paid any cash for every day of unexpected hospitalization.

A great way to prevent your supplemental coverage from lapsing is to engage the services of a licensed insurance agent in Texas. This professional, in addition to educating you on the most suitable hospital indemnity plan to opt for, can also notify you when your policy is on the verge of lapsing. In situations where your premium payments were paid but not received on time by your insurer, having an agent can eliminate the chance of this occurrence by ensuring the timely delivery of the renewal premium. They can also inform you of your lapsed policy and work with you to explore options for its possible reinstatement. When your lapsed policy cannot be reinstated, they can also help you shop around for alternative supplemental coverage with more affordable premiums.