The Need for Health Care Insurance

Health care insurance is a term used for covering medical expenses. This is being received through estimation of the overall risk of health care along with the expenses incurred among the target population. The financial structure for this is a premium that can be set monthly, semi-annually or annually. The coverage includes losses from accident, disability, dismemberment, medical expense, and accidental death.

The policy contract is between the insurance provider and the individual or his/her sponsor. It is renewable in three terms; monthly, semi-annually, and annually. There is specific amount of premium to be paid and is reflected in writing. And the policy is in a booklet.

Several Forms of Insurers Obligations:

       1.    Premium

 This pertains to the amount the insured or the sponsor pays for the health coverage.

      2.    Deductible

Out-of-pocket payment prior the insurer covers its share. There will be more visits from the doctor and prescriptions prior deductible and the insurer pays for health expenses. Most of the times, policies do not include co-pays for doctor’s visits and prescriptions.

      3.    Co-Payment

This is the amount paid by insurers out-of-pocket prior to insurer’s share of payment.

     4.    Co-insurance

This is the percentage of the total cost the policy holder pays.

     5.    Exclusions

This is the uncovered services. The policy holder pays full cost of the services that is not included in the coverage.

     6.    Coverage limits

This means that the coverage has specific service. Other services outside the coverage will be paid by the policy holder.

     7.    Out-of-pocket maxima

This is almost the same with coverage limits but with out-of-pocket maxima, the policy holder’s financial responsibility ceases after reaching the out-of-pocket maximum. The insurer pays the covered costs. It is limited though to certain types like prescription drugs or is applicable to all coverage that is embedded in a year contract.

     8.    Capitation

The insurer pays the total amount for a health care provider provided that he agrees to treat all members of the insurer.

     9.    Prior Authorization

The insurer provides an authorization or certification that states the insurer’s obligation to pay for the services provided. There are other services that will not require authorization though.

    10. Explanation of Benefits

This pertains to the document sent to the policy holder by the insurer. It is a written explanation of medical service coverage, the amount paid by the insurer, and the amount to be paid by the patient (insured).

Getting a health insurance is always a necessity. With the many risks that the world brings, getting sick is possible. What is not possible is an easy way to pay the bills when getting hospitalized. Therefore, insurance is a form of protection. It protects one from being huddled with high financial responsibility when sickness comes. Get your coverage from the most dependable company that offers more for less. Make sure that you understand the policy well and the premium is within your budget. There are a lot of health insurance companies that will solve your medical worries. Make the right choice.