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.
