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Things You Should Know Regarding Health Insurance

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 Things You Should Know Regarding Health Insurance
Things You Should Know Regarding Health Insurance

Things You Should Know Regarding Health Insurance

Yes, having insurance cover in place can give you sense of security, however, not knowing important details will make it worthless to invest in a plan. So even before you buy a plan, know that a health plan is a contract between you and the insurer. As long as certain benefits (medical) are listed/covered under your plan, insurer cannot deny you that benefit. Commonly covered benefits by almost every insurance plan are: testing, medical treatment for certain ailments, medical care and other services. These benefits are called covered services.

Understanding Waiver of Premium Provision

The waiver of premium provision can be a valuable benefit for you in the event you become severely ill due to which couldn't work for an extended period of time. Generally, this waiver of premium provision means you will not be liable to health insurance premium if you suddenly fall ill for extended period of time.

Medical Needs Might Not be Covered

You should have full knowledge of what's covered under your health insurance plan and what's not as physician can recommend prescription drug or treatment that might not be covered by your plan. Remember, insurer decides what's covered under your plan and not your physician. So before enrolling ask your insurance provider or agent to explain the policy in-depth.

Know About the Appeal Process

You should know you have the right to appeal the ruling if your health insurance claim is denied. You can consult your physician as s/he might be able to guide you on this. It's also a wise decision to learn how your insurance providing company deals with appeals before you make yours. Even if your insurance claim is denied, you can still get the treatment, but remember, you will have to pay for it.

Basic Health Insurance Cover

Major medical costs like hospital stays, surgical, and physician's expenses should be included in this coverage as major medical cover can safeguard your finances in the event severe illness/accident. You can enroll into basic health insurance and Major Medical Insurance separately, but usually they come in one policy.

The components of your health coverage and what's covered by provider should be clarified in your plan. it should also has information on what patient will contribute-deductibles, co-payments, and coinsurance, and about maximum out-of-pocket costs.

Elements of Basic Health Cover

Hospital Expense Cover

This is to cover hospital costs if you ever get hospitalized. And some health insurance plans pay the actual cost, regardless of the dollar amount. But most insurance plans pay a certain amount per day for a certain number of days. You should always carefully review this part in your policy as you could need range of services while in the hospital such as x-rays, anesthesia, lab tests, and monitoring equipment.

Surgical Expense Coverage

This cover is to cover expenses of most surgery fees and associated expenses. You can find what's covered and what's not in a table provided by your insurer on what procedures are covered. However, some health insurance companies are known to pay what is considered usual, customary, and reasonable (UCR) in a certain area.

Physicians Expense Coverage

This cover mostly pays for all the expenses related with physician's office visit. It's also known as known as regular medical expense insurance. There is normally for a maximum number of physician's office visits for each condition and a maximum dollar amount they will cover. It's usually listed in your health insurance policy.

Major Medical Insurance Cover

This sort of insurance plans protects enrollee from various expenses that could occur in case of severe illness or injuries. The policy is normally extremely broad with a high dollar amount for maximum benefits. At least $250,000 in coverage is nearly always part of this type of health insurance policy, but some experts recommend $1,000,000 or more in coverage.

Below is list of items usually covered under the major health insurance policies:

  • X-Rays
  • Lab services
  • Radiology
  • Blood (and plasma)
  • Ambulance services
  • Diagnostic tests including MRIs and CAT scans
  • Oxygen
  • Dental treatment for injuries
  • Prosthetics
  • Physicians services (surgical, medical, and diagnostic)
  • Anesthesia
  • Intensive care and other hospitalization (inclusive of all supplies and services including surgery)
  • Medication (prescription as well as other)
  • Nursing services and other medical services (including in-home care)

Read your health insurance policy for more information on what's included in your particular policy.

Things You Should Know Regarding Health Insurance


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