Mini Medical Plans For New York Residents

What is a Mini- Medical Plan?

A mini medical is a plan that provides limited medical benefits up to a fixed dollar amount with a designated number of occurrences allowed. For example, on doctor's office consultations, a mini medical plan caps the reimbursement to the policyholder amount up to a set dollar figure; let's say $100.00 per occurrence with a maximum of 4 visits permitted during a policy year. On the other hand, a major medical includes comprehensive coverage with higher benefits limits. Thus, the carrier and the policyholder cost-share in the expense of the medical bill at a split percentage rate, let's say, 80/20 or as a copayment amount up to a lifetime maximum. Hence, by limiting the benefit payout in a mini medical the carrier is able to offer lower premiums and utilize lenient underwriting criteria or none at all. In contrast, a comprehensive major medical plan is much more selective in their underwriting criteria while offering coverage at higher premium amounts.

Pre-existing condition and Health Insurance

As mentioned before, a major medical plan is more selective; therefore, the possibility exists for a carrier to decline your request for coverage during their full underwriting process mostly because of a pre-existing condition. The criteria vary from one insurance carrier to another and so does the cost of health insurance. Normally, insurance companies, such as, Aetna, Assurant, Golden Rule, Humana, take into consideration certain levels of risk based on your height to weight proportion, gender, age, credit worthiness, medical history, occupation, hobbies, lifestyle habits, as determinants for offering or declining coverage. If you happen to be overweight, some may accept you at a standard premium cost while others will impose a surcharge for what is considered a substandard risk. On the other hand, mini medicals reduce or eliminate their underwriting requirements, may or may not use premium surcharges for substandard risk, and are able to accept more members into their plans.

What is considered a pre-existing condition?

A pre-existing condition is any condition that you are currently being treated for. When insurance companies refer to pre-existing conditions is any serious, irreversible and/or terminal illness that won't go away. Examples include Advanced Emphysema/COPD, Major Cancers, High Blood Pressure, High Cholesterol, Eating Disorders, Massive heart damage or having been installed a pacemaker, AIDS, viral meningitis, Type A Diabetes, cirrhosis of the liver, or Acute Asthma in patients older than age 65. Almost any type of serious brain abnormality such as an AVM, Chronic Brain Tumors regardless if it is malignant, benign, or terminated will almost always constitute a pre-existing condition, naturally. 

Mini medicals are available as a stand-alone policy with insurance benefits only or with additional value-added features such as savings on prescriptions, dental, vision or chiropractic services, legal consultation, hearing professionals and more. There are a number of possible choices and finding what you need requires consultation with a licensed insurance professional knowledgeable with mini medicals plans.

How do you make a choice?

You may choose to do research on the available mini medical programs online or seek immediate guidance from our licensed insurance professionals.

We have the technology to sift through the number of choices available and recommend the appropriate mini medical plan that best fits your specific needs and budget!

Our licensed insurance agents are highly regulated, must take continuing education courses to maintain or increase their insurance knowledge, adhere to marketing compliance and professional ethical standards.