Florida Health Insurance Definitions

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"


Back to Resources |  Florida Health Insurance Homepage