Health Insurance is a contract between an individual and insurer (an insurance company) under which the insurer pays some or all of a person’s medical expenses in exchange for a monthly premium.
One thing you should also understand that if any person gets health cover, then if there is any problem in related to the person’s health, then that person first goes to the doctor and gets the check-up done.
And every expenses occurs will be paid by the insurer. Know why? Because the health policy that he has got done.
By getting health policy, the cost of the doctor will not be paid by the insurance company, nor will it be necessary to pay it to that particular person.
And know that it also benefits that person a lot. The first advantage was that he did not even pay all his doctor’s expenses and his full check-up was also done for free.
So that in this way that person’s illness was also prevented from turning into any major problems.
In this article, we will explain everything about a complete guide on health insurance.
What does Health Insurance policy cover ?
Let me now tell you what health policy covers and what do these essential benefits cover include:
A good health policy provides emergency services as well as outpatient care, the entire cost of hospitalization, whether it is surgery or overnight stay in the hospital, all the expenses are provided by a health insurances company.
Not only this, the insurances company provides all the expenses of pregnancy, maternity and newborn care before and after birth.
Moreover, it also provides services like mental health care and substance abuse disorder and also provides claims free of cost.
Types of Health Insurance Plans
You can buy health policy from anywhere from the market companies or from an agent. Always and always you often have many options to get this.
There are many types of health policy plans available in the market include:
- Health Maintenance Organization (HMO) plan
- Preferred Provider (PPO) plan
- Exclusive Provider Organization (EPO) plan
- Point-of-Service (POS) plan
- High-Deductible Health Plan
- Health Maintenance Organization (HMO) plan
HMO Insurance Plan has a network to get care from providers (insurers) and facilities within the same network unless it is an emergency.
Now this question must be coming in your mind that what is this network after all? So friends, let me tell you that a network is a group of providers and health facilities, who have contracted with the insurance company.
Under this contract, these networks allow you to choose a primary care physician with most HMOs depending on the individual needs.
That doctor will also provide you with a referral if you need to see another primary specialist or another specialist.
Any person who is associated with a particular Health Maintenance Organization plan and is not interested to remain in the network, then I can tell you that it can prove to be the best plan for you.
Moreover, for those who want low premium, this plan is also a best option. Now in other words, it usually help cover hospital expenses, doctor’s expenses, services, prescriptions and other medically necessary expenses.
This is much less expensive than all other plans such as Specialized Provider Organization (EPO), Point-of-Service (POS) and PPO plans.
- Preferred Provider (PPO) plan
A Preferred Provider (PPO) plan is a plan that also has a network similar to a HMO plan but with a Preferred Provider (PPO) plan, you can meet out-of-network providers.
Since you pay a bit more with this plan, you usually don’t even need a referral to see a specialist if you’re not in-network.
In this you are taken care of only a few extra needs. Because in this plan you are covered for hospitalization expenses as well as expenses like prescription medicines.
These plans are generally a bit more expensive than HMO, EPO and POS plans since you pay a little more in this plan.
- Exclusive Provider Organization (EPO) plan
Special Provider Organization plans are also somewhat similar to PPOs and HMOs. As we told you that they all work like a network.
If there is a small network in some plan, then big network in some plan. Similarly, EPOs are best for those who want a large network but also want to save on their premium.
EPO also covers all necessary expenses including hospital care, doctor’s visits and medicines.
As I have already told you that PPOs are more expensive, but EPOs are more expensive than HMOs and less expensive than PPOs.
- Point-of-Service (POS) plan
So far you have only seen external networks. A point-of-service (POS) plan is a plan in which you can view providers within or outside the network.
If you see provider with out-of-network then you will have to pay more money and if you look at provider with same network then you have to pay less money from outside provider’s network.
And if you work with out-of-network providers, you may have to do the claims paperwork yourself if you go out-of-network.
- High-Deductible Health Plan
Deductibles also vary in different plans, and some plans are even designated as high-deductible health plans (HDHPs). In this plan you can also link these plans to a Health Savings Account (HSA).
These are considered best for those individuals who have money but often do not use healthcare and want low premiums.
So for this type of people, HDHP low deductible plans have been designed, which is a less expensive plan.
How Much Does Health Insurance Cost?
It depends on some of your factors. These are some of the factors that can increase or decrease your health insurances costs.
According to HealthCare, there are some factors that can increase or decrease an individual’s monthly premium, and they are as follows:
- Your age : First of all, you should know that as your age increases, your health also goes down. And that is why health insurances charges you the premium amount according to your age. So now you must have understood that premiums can be higher for older people as compared to younger ones.
- Your location : The premium of your insurance also depends on your location. And this premium also depends on factors like your location’s government’s state rules.
- Tobacco use : A higher premium is also charged from the person who consumes particular tobacco because the risk of the insurance company on their health increases even more. And those who do not consume tobacco are charged a lower premium by insurance companies than those who consume tobacco.
Conclusion:
In this article, we have told you about health insurance meaning, types and how it works. If you liked this article, then please share this post to those who do not know about it.
