Health Insurance

Health InsuranceHealth insurance (widely known as Mediclaim or Medical Insurance) as a term denotes a kind of insurance which covers medical expenses.The idea of health insurance may be new to India but its followers are growing fast. This insurance is quite handy if you suffer a severe injury. Life is unpredictable, so insurance can add a little safety and security from bearing a huge financial. A health policy is the contract between the insurance company and the individual. Sometimes this is connected with covering custodial needs and disability. The contract is renewed annually.

Health insurance is affordable and carries the assurance and freedom from insecurities that threaten normalcy now and then. The type and amount of health care costs that will be covered by the health plan are specified in advance. Health plans are available in two formats, individual and group plans. In an individual policy you are personally the owner of the policy. While in a group plan, the sponsor owns the policy and the people covered under it are called its members.

The insured individual’s obligations might take several forms:

  • Premium: The amount a policy-holder or a sponsor (for example an employer) pays for the health plan in order to purchase a health coverage.
  • Deductible: The money that the insured perso have to pay out of his pocket before a health insurer pays his own share. For instance, policy-holders may need to pay $500 deductible every year, before any health care gets covered by their health insurer. It might take several doctor visits and prescription refills before an insured person gets to the deductible and his insurance company starts paying for the care.
  • Co-payment: The money that the insured must pay himself before his health insurer has to pay for a particular service or visit. For example, the insured person may pay $45 as co-payment for his doctor's visit, or even to get a prescription. The co-payment has to be paid every time you obtain a particular service.
  • Coinsurance: Instead of paying up front a fixed amount(a co-payment), this co-insurance is a per cent of the total cost which the insured person might also pay. For instance, the member may have to pay twenty percent of the surgery cost above and over a co-payment, and the insurance company must pay the remaining 80%. If there’s an upper limit of coinsurance, this policy-holder may end up owing little, or a huge amount, depending on the real costs of the received services.
  • Exclusions: Not all the services are covered. Insured people are normally expected to cover the full amount of non-covered services with their own finance.
  • Coverage limits: A few health insurance policies pay only for health care to a certain amount. The insured is expected to pay all charges above the health policy's maximum payment towards a specific service. Additionally, some insurance schemes have lifetime or annual coverage maximums. Under these cases, a health plan stops payment when it reaches the benefit maximum, so the policy-holder has to pay all the remaining costs.
  • Out-of-pocket maximums: Resembling coverage limits, except in the case that the insured person's obligation to payment ends if they reach an out-of-pocket maximum, so the health insurance must pay all further costs. Out-of-pocket maximums may be limited to some specific benefit category (like prescription drugs) or could apply to all the coverage provided in a specific benefit period.
  • Capitation: Money paid by the insurer to the health care provider for which this provider agrees to care for all clients of this insurer.
  • In-Network Provider: (U.S. term) The health care provider with a list of preselected providers. The insurer offers discounted co-payments or coinsurance, or extra benefits, to his plan members to see the in-network provider. Normally, providers in a network are those who have a formal contract with the company to accept rates discounted from the "customary usual " charges an insurer gives to out-of-network service providers.
  • Prior Authorization: An authorization or certification that an insurer gives prior to the medical service occurring. Getting an authorization means the insurer is forced to pay for this service, assuming it is authorized. A lot of smaller, routine services don’t require authorization.