Health insurance is a type of facility that covers for settlement of expenses arising out of ill-health or injury including accident, disability, death by accident and amputation of limbs to individuals. For rendering such a compensatory benefit, the organization operating the plans collect an amount known as premium or payroll tax from the individuals insured or the group responsible for their insurance. Normal agencies floating such schemes are either private concerns, or non-profit organizations or government bodies. The Health Insurance Association of America, the apex body on such issues, regulates those operations in the US.
A health insurance is executed as a written agreement called “Evidence of Coverage” between the individuals or their patrons on one hand and the insurance provider on the other on monthly, annual or life-long basis. Such options are available only for privately-operated schemes, whereas they are mandatory in the case of “national plans for all citizens.” Yet other employer-sponsored self-funded plans are floated by certain individual companies, with some of them operating the schemes themselves without enlisting insurance providers from outside. Such schemes are controlled by the US Department of Labor (USDOL).
Premium payment modes, coverage of diseases and other terms and conditions determine the policies. You understand the present perspective and go by your specific needs.
This is the subscription amount the insured individuals or the sponsor (the employer) remits toward the health plan.
Co-payment is payable each time a consultation is availed of. The insured individuals are to pay from their pocket their share, followed by the health insurer paying its share for such a consultation.
This forms the amount which the individuals are to pay from their pocket before the insurer pays its share. That is, if the individual policy-holders pay $400 deductible a year (upto a deductible limit), the insurance company commences paying for the health care beyond this.
Unlike co-payment which means a fixed upfront payment for each visit to a doctor, coinsurance means payment as a percentage of the total cost. For instance, if the individual pays 25% of the cost, the insuring company will pay the balance 75%.
In health insurance, all services are not covered; there are exceptions. They also differ amongst policies. The insured individuals have to bear the full amount in such ineligible cases.
This is one certification the insurance company mostly gives in major cases to policy holders before their availing the medical facility, as a matter of “prima facie no objection.
Ceilings are fixed in the matter of paying for some medical procedures or on total expenditure in certain policies. In such cases, the insured are to meet the excess expenditure from their own purse.
This is the amount paid by an insurance company to a health care facility who in turn agrees to treat all members of the insurer as a contract.
When the member crosses the out-of-pocket maximum which is the maximum share the member has to bear, the health insurance provider meets all the further costs. This limit can pertain to a specific category of service like prescription drugs, or a particular benefit year.
The insurance company offers concessions and discounts to its policy-holders. Health care providers, who are authorized by the insurer and known as In-Network Providers, will render these services at the reduced rates as per their contract.
When you sign for a health insurance policy, ascertain all the pros and cons with an expert’s help so that you derive maximum benefits.
Auto insurance is a contract between the customer and the insurance company.
Finding home insurance gets better if you have some basic knowledge about it.