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HEALTH INSURANCE TUTORIAL >
Simply put, health insurance is protection against medical costs. A health insurance policy is a contract between an insurer and an individual or family or a business (on behalf of its eligible employees) in which the insurer agrees to provide specified health insurance at an agreed-upon price (the premium). Depending on your policy, your premium may be payable monthly or in installments.
Health insurance usually provides either direct payment or reimbursement for expenses associated with wellness, illnesses, injuries and pregnancy ( maternity coverage is an optional benefit on some policies ). The cost and range of protection provided by your health insurance will depend on your insurance provider and the particular policy you purchase. If your employer does not offer a health insurance plan, you may wish to purchase health insurance on your own. With some exceptions, you will have to medically qualify ( ie be in reasonably good health according to insurance company guidelines) in order to be approved for an individual policy.
The most popular types of plans available to businesses and individuals are PPO ( or Preferred Provider Organization plans( similar to POS ( Point of Service ) where available ) and HMO ( Health Maintenance Organization ). Health Savings Account plans are similar to PPO plans ( with limited Bells & Whistles as described below ) with a tax-favored component.
PPO plans typically have a few basic components which drive the premium and your out of pocket costs for medical care. Deductibles, usually based on a calendar year, range from $500 to several thousand dollars and have to be satisfied before many services are paid by your policy.Coinsurance ( a sharing of costs between you & the insurance company ie 80/20 ) follows up to a pre-determined amount called a Stop Loss. The insurance company then pays 100% usually up to a Lifetime Maximum. Many policies have Bells & Whistles which we define as those Covered Services which do not require a Deductible and/or Coinsurance to be satisfied in order to be paid. It is very important for you to understand the provisions of your policy so you are not surprised when a claim is incurred. We are here to Help & Educate.
HMO plans typically have NO deductibles or coinsurance (although some now have deductibles & coinsurance with a lower monthly premium ) or lifetime maximums but usually require referrals for most covered services and have limited out of network coverage. Your cost for medical service incurred is based on a pre-determined fee called a co-payment which is typically paid at time of service delivery.
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