Health insurance is a type of insurance coverage, which covers the cost of medical and surgical expenses of an insured person. What is health insurance.
The insurer uses the term “provider” to describe a clinic, hospital, doctor, laboratory, health care professional, or pharmacy that treats a person. “Insured” is the owner of a health insurance policy or person with health insurance coverage.
Depending on the type of health insurance coverage, either the insured person pays by pocket and receives reimbursement, or the insurer directly pays the provider.
In countries with universal health care coverage such as the United States, health insurance is usually included in the employer benefit package.
According to the Caiage Family Foundation, the number of people insured in 2013 decreased from 44 million in 2013 to less than 28 million in 2016. Researchers put it down for recent changes in the law.
It is reported in the Commonwealth fund 2011 report that one-fourth of all working American citizens experienced a difference in health insurance coverage. Many people in the survey lost their health insurance when they either became unemployed or changed jobs.
The level of treatment in emergency departments is quite different depending on which type of health insurance a person has.
type
There are two main types of health insurance:
Private Health Insurance: Centers for Disease Control and Prevention (CDC) say that the American Health Service relies heavily on private health insurance. In the National Health Interview survey, researchers found that 65.4 percent of people under the age of 65 in the US have a type of private health insurance coverage.
Public or government health insurance: In this type of insurance, the state offers a subsidy on healthcare instead of premium. Medicare, Medicaid, Veteran Health Administration and Indian Health Service Examples of public health insurance are:
other types
People also defined the insurer in how to administer their plans and to engage with healthcare providers.
Managed Care Plan: In this type of plan, the insurer will have an agreement with the network of health service providers to provide low-cost medical care to their policyholders. There will be penalties and extra costs for network hospitals and clinics, but they will provide some treatment.
The more expensive the policy will be, the more flexible it will be with the network of hospitals.
Indemnity, or Duty-Service Plan: A duty-service plan covers treatment equally among all health care providers, allowing the insured to choose his preferred place of treatment. The insurer will usually pay at least 80 percent of the cost on the compensation plan, while the patient pays the remaining costs in the form of co-insurance.
Health Maintenance Organization (HMO): These are organizations that offer direct medical care to the insured. The policy will usually be a dedicated primary care physician who will coordinate all the necessary care.
HMO will generally fund the treatment referred to by this GP and will negotiate the fee for each medical service to reduce the cost. This is usually the most affordable type of plan.
Preferred Provider Organization (PPO): A PPO is similar to the compensation plan, in which they allow the insured to like any doctor.
The PPO also has a network of approved providers with whom they have negotiated the cost.
Insurers will pay less for treatment with out-of-network providers. However, on a PPO plan, people can self-render experts without meeting primary care physicians.
Point-of-Service (POS) scheme: A POS scheme works as a mixture of HMO and PPO. By adjusting all the remedies through the insured primary care physician, the insurer’s provider can choose between receiving treatment within the network or using non-network providers. The type of plan will determine the progress of treatment.
Why is the type of insurance plan important?
The type of plan determines that a person has to approach for achieving the treatment they need and how much money they have to pay on that day.
Point-of-Service (POS) scheme: A POS scheme works as a mixture of HMO and PPO. By adjusting all the remedies through the insured primary care physician, the insurer’s provider can choose between receiving treatment within the network or using non-network providers. The type of plan will determine the progress of treatment.
Why is the type of insurance plan important?
The type of plan determines that a person has to approach for achieving the treatment they need and how much money they have to pay on that day.
In 2003, the US Congress introduced a new option, the Health Savings Account (HSA). This is a combination of savings account with an HMO, PPO, indemnity plan and tax benefit. However, a policyholder should be linked with an existing health plan, in which there is a reduction of $ 1,100 for individuals and $ 2,200 for families.
HSAs can cover coverage, expanding existing plans to cover a wide range of coverage. If an HSA is paid by the employer for its employees, the payments are tax-free. A person can build wealth in HSA while they are healthy and save later in life for examples of poor health.
However, people with chronic conditions like diabetes can not be able to save large quantities in their HSA because they have to pay higher medical costs regularly to manage their health concerns.
These plans are often very much deductible, which means that although premiums may be reduced, people often spend the full amount of any medical treatment.
What is health insurance
There is more overlap with plan type development. The difference between policy types is becoming more and more blurred.
Most of the indemnity plans use managed care techniques to control costs, and to ensure that there are adequate resources for proper care. Similarly, many managed care plans have adopted certain features of the fee-by-service plans.
Legislation
U.S. In some extent, insurance is currently required as part of the Affordable Care Act (ACA) 2010. Without a health insurance, a person has to pay a fine.
However, the individual mandate in the ACA has been removed from the law, which means that there will no longer be a legal requirement for insurance in the US till 2019.
Related : Health Insurance
If the policy also includes children in the family, then a person is allowed to stay on the life of his parents till the age of 26, even if they are:
married
Stay away from home
Are not financially dependent on their parents
Eligible to join on the cover of their employer
Insurance is regulated at the state level, which means that buying a policy in one state is different from doing so in the other.
fWhile state law can affect the price of a policy, important decisions about the cover and reimbursement of a person rest with the insurer. People should be sure to discuss the impact of any changing law on their particular policy to their broker or customer service representative.
Source : medicalnewstoday
