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Health Insurance - A Comprehensive Overview

Health Insurance - A Comprehensive Overview

A medical requirement in todayís fast paced world is something we cannot bargain with. However, income for anybody is not unlimited. Therefore managing our medical requirements with our limited income is what an effective health insurance can help us to do.

TYPES OF HEALTH INSURANCE AVAILABLE:

Health Insurance can be broadly classified in two categories:

  • Indemnity or reimbursement plans
  • Managed Care Plans (e.g. HMOs, PPOs, POS plans)

INDEMNITY PLANS

Under indemnity plans we need to select our own doctors for consultations, visit facilities of our own choice for treatment. The medical expenses would be reimbursed by the insurer to a pre-specified extent per day or a number of days.

MANAGED CARE PLANS

Under this category the coverage provider takes care of almost the entire medical expenses, however there is an arrangement involved between the insurer and selected medical care facilitators like physicians, nursing facilities, labs etc.

However, it is important to check in both cases, that the plan covers, the right kind of coverage that we are looking for. Therefore we should first understand what the different factors a good policy should cover are.

COVERAGE TO LOOK FOR:

The ideal health insurance plan should have:

  • Hospital expenses like room charges, incidental service costs and board expenses.
  • Surgical expenses like surgeonís fees and expenses related to surgery.
  • Physicianís expenses as in visits to the doctor and doctorís visit to the hospital.
  • Broad coverage with high benefits, which are designed to protect us against critical illness and surgery.

However apart from the above the above points we should also check if the following benefits are also covered:

  • Prescribed medicines and drugs
  • Preventive Care
  • Mental Health Benefits
  • Maternity Care
  • Vision Care

THE PRICING FACTOR

Apart from regular monthly premiums there are certain other costs that might be needed to be paid and the amount can be quite substantial if you have children or other family members who are to be covered under the plan. Therefore we need to check we need to pay any or all of the following additional payments in due course or beginning of a plan:

Co-Payment:

This is the amount which we need to pay each time we pay a visit to the insurer. This is commonly observed in case of a Health Maintenance Organization (HMO).

Deductible:

This is the sum of money one needs to pay for medical expenses before the insurer starts paying for the rest of the medical expenses as per agreement. Generally the payment is calculated annually and this is typical feature for indemnity or reimbursement plans.

Co-insurance:

This is the percentage of any medical cost that needs to be borne by the patient after he/she reaches any deductible which may apply.

PLACES TO LOOK FOR A GOOD HEALTH INSURANCE

The first and most obvious place to look for a comprehensive health insurance plan is at your workplace. This would be through a group insurance plan wherein the premium and other costs are much less since there would be group discounts available. Other group plans might be available through other group affiliations such as schools or clubs.

Second option is to purchase an individual health insurance plan on your own. The advantages for doing so are that, you can customize the plan according to your specific needs. However, for this you need to do a lot of online shopping, wherein you can get online estimates and comparisons.

BEST AFFORDABLE MEDICAL INSURANCE PLAN

Following are three most basic criteria to decide on the best available plan:

  1. Greatest flexibility
  2. Maximum Benefits
  3. Low Cost

However, whenever we shop around to find quotes online following points should be kept in mind:

  • What are the co-payments, deductibles and co-insurance involved?
  • How much flexibility is there for selecting your own health care provider?
  • Are Health Service costs covered?
  • Are your preferred health-care providers covered under the plan?
  • Does the plan cover both family as well as individual care?
  • Are pre-existing diseases and what is the waiting period involved?
  • What is the rating and reputation of the company in the market?

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