Florida Health Insurance Terms:
Define: "Covered Expenses"

In health insurance, covered expenses means "reimbursement" for an insured's medically related expenses, including room and board, surgery, medicines, anesthetics, ambulance service to and from a hospital, operating room expenses, X-ray, and fluoroscope.

What is usually covered?

• Medically necessary and appropriate services in a physician's or other practitioner's office.
• Routine diagnostic services.
• Prescription drugs (subject to deductible and paid at 80 percent).
• Inpatient hospitalization including room and board in a semi-private room, general nursing care, medications, injections, diagnostics and special care units. (Certain services require prior authorization or benefits will be reduced or denied.)
• Emergency care services.
• Skilled nursing facilities (limited to 10 days per policy term).
• Therapy services including physical, speech, occupational, manipulative, cardiac and pulmonary rehabilitative (10 visit limit per benefit period).
• Home health services (10 visit limit per benefit period; prior approval must be obtained).
• Temporomandibular Joint (TMJ) ($500 limit per benefit period).
• Durable medical equipment.
• Prosthetics and orthotics.
• Ambulance services.

In business interruption insurance, reimbursement of an insured for loss if a business cannot operate, including payroll expense and taxes.

News Article: More About: "Covered Expenses"

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