How Health Insurance Works
Feb 28, 2009 Health Insurance
How health insurance works.
When I consider purchasing an individual health insurance plan for myself or my family, do I have any financial obligations beyond the monthly premium and annual deductible?
Answers: It depends on the plan, but typically.
•Co-Payments: Some plans include a co-payment, which is typically a specific flat fee you pay for each medical service, such as for an office visit. After the co-payment is made, the insurance company typically pays the remainder of the covered medical charges.
•Deductibles: Some plans include a deductible, which typically refers to the amount of money you must pay each year before your health insurance plan starts to pay for covered medical expenses.
•Coinsurance: Some plans include coinsurance. Coinsurance is a cost sharing requirement that makes you responsible for paying a certain percentage of any costs. The insurance company pays the remaining percentage of the covered medical expenses after your insurance deductible is met.
•Out-of-pocket limit: Some plans include an out-of-pocket limit. Typically, the out-of-pocket limit is the maximum amount you will pay out of your own pocket for covered medical expenses in a given year. The out-of-pocket limit typically includes deductibles and coinsurance. But, out-of-pocket limits dont typically apply to co-payments.
•Lifetime maximum: Most plans include a lifetime maximum. Typically the lifetime maximum is the amount your insurance plan will pay for covered medical expenses in the course of your lifetime.
•Exclusions & Limitations: Most health insurance carriers disclose exclusions & limitations of their plans. It is always a good idea to know what benefits are limited and which services are excluded on your plan. You will be obligated to pay for 100% of services that are excluded on your policy.
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Health Insurance Policy Terms
Dec 14, 2008 Health Insurance
(Best Syndication) Employer based health coverage is disappearing leaving many employed individuals to make their own health care insurance decisions. Due to the high cost of health insurance, many employers are either scaling back their coverage or eliminating it all together, according to a survey by the non-partisan Kaiser Family Foundation.
So what are the differences in health care planes, and which one is best for you? This presentation will provide some information. But first: what is health insurance? Health insurance is a form of group insurance, where policy holders share the risk. Not everyone gets sick at the same time, so most of the premiums go to paying the expenses of those who are. For the most part, in the United States, health insurance is provided by private insurance companies who must make a profit. .
Here are some terms:
Premium: A premium is the amount of money the policy holder pays each month for their coverage.
Deductible: The deductible is the amount the policy holder has to pay out-of-pocket before the health plan kicks in and pays. If a policy holder has a ,000 deductible, he or she must pay the first one thousand dollars. The expenses may include doctor’s visits, medication, hospitalization etc.
Copayment: The copayment is the amount that the policy holder must pay for a doctor’s visit or other service. For instance, a policy holder may have to pay a co-pay for each doctor visit.
Coinsurance: Coinsurance is similar to a copayment, except this is a “percentage” the policy holder must pay for a service. A customer may have to pay 20% of the cost of surgery.
Coverage Limits: The coverage limit is the maximum an insurance company will pay for a procedure. For instance, if an insurance company only will pay a maximum 0,000 for heart surgery, but the hospital charges 0,000, the policy holder will have to pay the extra ,000.
Maximum annual or Lifetime Coverage: The lifetime coverage is the maximum an insurance company will pay out in total over your lifetime. There maybe yearly caps as well.
Out-of-pocket Maximums: The out of pocket maximum is where the member’s payment obligation ends. The health insurance company may pay all of the costs after this level is reached. For instance, some insurance policies will pay for every prescription drug after the 0 yearly threshold is reached.
Exclusions: The insurance company may exclude certain procedures or drugs. They may exclude experimental options.
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