Frequently Asked Questions

Coverage C, the named perils coverage, applies to all your personal property (except property specifically excluded) at your described premises up to the limit of the policy. Usually property away from your property would be covered up to 10% of the contents limit.

(Note: this answer is based on the Insurance Services Office’s HO-3 policy.) Coverage A and B cover your dwelling and other structures on the premises subject to certain exclusions. On HO form 3 Special Form any peril NOT excluded would be covered.

You set the limit for Coverage A when you buy the policy. The Coverage B limit is usually equal to 10% of the policy limit on Coverage A. Coverage C covers losses to your personal property on a “named perils” basis, which means you’re covered for all the perils specifically named on your policy. The policy limit on Coverage C is equal to 50% of the policy limit on Coverage A. Coverage D covers extra expenses you may incur when the residence can’t be used because of an insured loss. The policy limit for Coverage D is equal to 20% of the policy limit on Coverage A. You choose the Coverage E – personal liability -limit when you buy the policy. The limit on Coverage F – medical payments to others – is usually set at $1000 per injured person. Individual companies may vary. Additional amounts of coverage can be purchased as needed.

Covered losses under a homeowner’s policy can be paid on either an actual cash value basis or on a replacement cost basis. When “actual cash value” is used, the policy owner is entitled to the depreciated value of the damaged property – so the older the item is, the less money you may receive for it. Under the “replacement cost” coverage, the policy owner is reimbursed the amount it costs to replace the property with something of a similar type and quality at current prices.

Homeowners Insurance is one of the most popular forms of personal insurance on the market. The typical homeowners policy has two main sections: Section I covers your property, and Section II provides personal liability coverage (to cover you in case of lawsuits arising from things that happen on and off your property). Almost anyone who owns or rents property should have this type of insurance.

A preexisting condition is often defined as a medical condition (i.e., an injury or illness) for which treatment was received or recommended during the 6 months prior to the insured’s effective date of coverage under a health plan.

A preexisting conditions clause excludes coverage for preexisting conditions for possibly as long as 12 months after the effective date of coverage, but can be shorter. Pregnancy is not a pre-existing condition.

Although providing very broad coverage, most plans typically contain a number of exclusions. Common exclusions include medical expenditures arising from:

  • Cosmetic surgery unless required to correct a condition resulting from an injury or a birth defect
  • Occupational injuries and illnesses that are otherwise covered under a Workers’ Compensation law
  • Routine dental and vision care (care required for treatment of an injury and dental and eye surgery are frequently covered, however)

Other common exclusions relate to benefits provided by government agencies (e.g., VA hospitals) and expenses paid under other insurance programs, including Medicare and Personal Injury Protection Coverage under your Personal Automobile Policy.

Most plans available today do not require a referral to see a specialist, but you will still need to get pre-authorizations for some procedures.

Most of the plans we see today are either an EPO ( Exclusive Provider Organization) or HDHP (High Deductible Health Plan). There are others, but these are the most common.

EPOs have copays for office visits, most tests and prescriptions. Hospital stays, surgery and invasive tests are generally covered after a deductible or cost-sharing is applied.

HDHPs are usually coupled with a Health Savings Account (HSA) and have a deductible of at least $1,150 before the insurance portion kicks in. The deductible can be as high as $5,950 for an individual and $11,900 for a family. These deductibles are indexed annually.