Health insurance is insurance against the risk of incurring medical expenses among individuals. By estimating the overall risk of health care and health system expenses, among a targeted group, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to ensure that money is available to pay for the health care benefits specified in the insurance agreement. The benefit is administered by a central organization such as a government agency, private business, or not-for-profit entity.
A good percentage of people are aware about the benefits of good health and suitable medical cover, but a large percentage still looks at health insurance as a tax saving instrument. A recent ICICI Lombard survey of 1,400 young people in the age group of 25-35 years had 75% of the respondents saying that they had health insurance.
But 46% of the buyers said that the tax deduction on health insurance premium was what made them buy the health cover. The quest for tax benefits was more pronounced among female respondents, with 64% citing it as the reason for buying the cover. The survey findings show that most people buy insurance only to save tax and not for the benefits it offers.
1. What does the plan cover:
Insurance sold to people and small businesseses must cover 10 “essential health benefits.” Any plan you buy, whether through your state’s Health Insurance Marketplace or not, will pay for these services.
Emergency services , Hospitalization , Laboratory tests , Maternity and newborn care , Mental health and substance-abuse treatment , Outpatient care , Pediatric services, including dental and vision care ,
Prescription drugs , Preventive services and management of chronic diseases such as diabetes
Rehabilitation services .
The rules for insurance provided by large employers are a little different but the vast majority them will cover the same set of benefits. To make sure, ask your employer for the Summary of Benefits and Coverage, a standard form that will state exactly what the plan covers and doesn’t cover.
2. How much does the plan cost:
You pay for health insurance in two ways:
The monthly premium that you pay to purchase your plan.
The out-of-pocket expenses you pay when you receive medical care. Those are some combination of deductibles, coinsurance, and copays.
In general, if you pay a higher premium upfront, you will pay less when you receive medical care, and vice versa.
If you purchase coverage through your state’s Health Insurance Marketplace, you may be eligible for income-based subsidies that lower the cost of your premium and in some cases your out-of-pocket expenses.
Before deciding on a premium budget (how much per month you can spend on health insurance), you’ll want to consider your regular monthly expenses and your typical health expenses.
3. How do use policy:
Each insurance company has different rules for using health care benefits. In general, you will give your insurance information to your doctor or hospital when you go for care. The doctor or hospital will bill your insurance company for the services you get.
4. How to use an insurance card:
Your insurance card proves that you have health insurance. It contains information that your doctor or hospital will use to get paid by your insurance company. Doctors usually make a copy of your insurance card the first time they see you as a patient.
Your card is also handy when you have questions about your health coverage. There’s a phone number on it you can call for information. It might also list basics about your health plan.
5. How to find a doctor or hospital:
You can call your insurance company using the number on your insurance card. The company will tell you the doctors and hospitals in your area that are part of their network. You can also find this information on the insurance company’s web site.