Healthcare Insurance

October 29th, 2011

At the start of 2014 (which is 3 years from now), U.S. citizens are mandated to have their own healthcare insurance or other qualifying health coverage. Health insurance coverage is either coverages purchased through the company, government plan, or a health plan.  Therefore, a portion of uninsured citizens are obliged to purchase their own healthcare insurance. If they fail to, they are fined with tax penalties that are increasing every year according to changes of costs of living and other economic changes. However, there are also exemptions granted. Such exemptions include financial hardship, imprisonment, undocumented immigrant, and American Indian to name a few.

Healthcare insurance will save an individual from possible risks against health care and medical expenses. Typically, a health insurance policy includes a contract, coverage and several insurers’ obligations. Let us understand the terms used in a healthcare insurance below:

The contract

The contract binds the agreement between the insurance provider and the individual. Insurance provider can be a company or a government. A contract may also be initiated by an individual’s sponsor such as community organization or employer which they will be the one building the contract which of course, with the permission of the insurer.

The coverage

The coverage details the specific assigned benefits the insurer can claim against its insurance provider for any medical and health care need.

Claim – is a notification to the insurance provider/company from the insured for a payment that has been due under the provision of the insurance policy.

Co-payment – An added charges paid by the insured patient after the deductible for covered services and supplies.

Deductible – is the fixed amount deducted from the eligible expenses after the benefits of the insurance which the insurance company are payable.

Limitations – are conditions where the providers are not liable in paying because of the limitations of the benefits. Thus, isn’t included in the insurance policy. Before every start of coverage, it is imperative to read the limitations, exclusion and or reductions policy written in the certificate of insurance or the insurance contract. Such knowledge would let you determine any expenses not covered by the healthcare insurance.

Medical necessary - insurance policies primary role is to cover a person’s medical and health care needs. Thus, they only pay for treatments deemed “medically necessary” for the person insured. Cases such as plastic surgery are not covered because this is not a health care or medical need but a cosmetic purpose.