Basic Medical Expense
Basic coverages provided by an individual medical expense policy include hospital expense, surgical expense, and medical expense. These three basic coverages may be sold together or separately. Frequently this is written as first dollar coverage, which means it does not have a deductible.

Hospital Expense Benefits
As the name implies, hospital expense coverage provides benefits for expenses incurred during hospitalization. Hospital indemnities are usually classified into two broad groups:

• Room and board, including nursing care and special diets
  
  
• Miscellaneous medical expenses, including x-rays, lab fees, medications, medical supplies, and operating and treatment rooms

In some cases, surgical benefits may be included for certain types of surgery and associated costs.

Room and Board Benefit
Hospital expense coverage provides benefits for daily hospital room and board and miscellaneous hospital expenses (not including telephone and television) while the insured person is confined to the hospital. The policy may provide for a certain dollar amount for the daily hospital room and board benefit, although the trend is toward coverage of not more than the semiprivate room rate unless a private room is medically necessary.

When room and board (R&B) are covered on an indemnity basis, the insurer pays a specified, preestablished amount per day, as shown in a schedule in the policy, for a stated maximum number of days. Indemnity policies are sometimes called dollar amount plans. R&B rates will vary by geographical location. Typically, the maximum number of days is from 90 up to 365. More commonly, room and board expenses are paid on a reimbursement basis.

This is also referred to as an expenses-incurred basis. Under this arrangement, the policy will pay in one of two ways: the actual charges for a semiprivate room, or a percentage of the actual charges with no specific dollar limit. A
maximum number of days will still be specified.

Some room and board benefits include intensive care, which may be paid in full or in part. Hospital plans with this provision generally provide for a maximum intensive care benefit of some multiple of the room and board maximum
—usually two or three times.

Surgical Expense Benefits
Surgical expense policies pay surgeons’ fees and related costs incurred when the insured has an operation. Related costs might include fees for an assistant surgeon, an anesthesiologist, and even the operating room when it is not covered as a miscellaneous medical item