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Saturday 2 February 2013

What is Health insurance?



Health insurance is insurance against the risk of medical expenses incurred between individuals. By estimating the overall risk of healthcare expenses and health care systems in a target group, the insurance company, a routine finance structure, such as a monthly premium or payroll tax, to ensure that pay the money available for health care services in the insurance contract. The benefit is administered by a central organization such as a government agency, private companies or non-profit organization.



A health insurance policy is:

1) a contract between an insurance provider (eg an insurance company or a government) and an individual or sponsor / (such as an employer or a community organization). This contract may be extended (eg annually, monthly) or lifelong in the case of private insurance or compulsory for all citizens in the case of national plans. The type and amount of health care costs will be covered by health insurance in writing. Contract or "Evidence of Coverage" manual for private insurance or national health policy for public insurance.

2) coverage of employer-funded insurance plan is self-funded ERISA always. The company announced that generally have one of the big insurance companies. But in the case of ERISA insurer "did not participate in the insurance act" is easy to handle. Therefore ERISA plans are not subject to state law. ERISA plans are governed by federal law under the jurisdiction of the U.S. Department of Labor (USDOL). Special benefits or coverage details are available in the Summary Plan Description (SPD). Complaints must go through insurance, employer plan administrator. If still needed, the results can trust USDOL ERISA compliance evaluation will take place and then filed suit in federal court.


Bonds insured individual can take several forms:
Premium: The amount the policy holder or the sponsor (eg an employer) pays to the health plan to purchase health insurance.

DeductibleAmount to be insured to pay out of pocket before the insurance pays its share. For example, an insured person has to pay $ 500 a year less before your care is covered by health insurance. It may take several doctor's visits or prescription refills before the insured and the insurance company achieve clean start to pay attention to, however, public policy does not apply to co-payments for doctor visits or prescriptions your deductible.

Co-payment: the amount of the insured to pay out of pocket before the insurance company to pay a visit or service. For example, an insured person to pay a $ 45 co-payment for doctor visits, or to obtain a prescription. A co-payment must be paid each time a particular service is obtained.

Coinsurance: Instead of or in addition to paying a fixed sum to the front (charge), co-insurance percentage of the total cost that insured person may also pay. For example, members must pay 20% of the operating costs and co-payment, while the insurance pays the remaining 80%. If there is co-insurance limits, policyholders can end up owing very little, or a lot, depending on the actual cost of the services they receive.

Exclusions: Not all services are covered. The insured are generally expected to pay the full cost of services that do not fall out of my pocket.

Coverage limits: Some health insurance companies only pay for health care up to a certain dollar amount. Insured may be expected to pay all the costs to the maximum payment for a specific plan health services. In addition, some insurance companies plan maximum annual coverage for life or lives. In this case, the health plan will stop payment when they reach the benefit maximum, and the policy must include all other charges.
Out-of-pocket maximum: Due to coverage limits, except that in this case the assured payment obligation ends when you pay the maximum out of reach of pocket health insurance and any other costs. Out of pocket maximum can be a particular benefit category (such as drugs) or can be limited to a specific benefit coverage all year.

Payment Calculation: The amount the insurer to the provider of health care provider agrees to pay to treat all members of the insurer.

In Network Provider: (U.S. term) A provider of health care providers in the list prepared by the insurance company. The insurer will offer discounted coinsurance or copayments, or additional benefits, to a member of the plan to view the service on the network. In general, the network provider contracts with suppliers who receive lower insurance charges deducted from the "usual and customary" insurer pays to out network.

Truth Before: A certification or authorization that an insurer provides prior to medical service occurring. Getting permission means that the insurer is responsible to pay for the service, assuming it matches what was approved. Many smaller, routine services do not require authorization. [3]
Clarification Benefits: Amount Amount A document explaining the insurance company to the patient, which can be transmitted by a covered medical services, and the method of payment and patient liability has been determined.


Prescription drug plans provide a form of insurance through a health insurance plan. In the United States, patients often die Zaun insurance copay and prescription drug Farmaco Bilanzsumme or drugs covered by the drug plan. This plan is part of the National Health Insurance program routine. For example, in the Province of Quebec, Canada, prescription drug insurance is universally required as part of the plan for public health insurance, but can be purchased and administered through private plans ja ein Meer or group, or through a public plan.

Some, if not most health care providers in the United States agree to bill the insurance company if they are patients willing to sign an agreement to be responsible for the amount keine insurance company pays. The insurance company pays the network provider according to a bob 'gewöhnlichen reasonable ", they may share the Lesser normal provider. Providers can also Dunner separate contract with the Insurance Company equivalent eine eine receive a discounted rate or standard load calculations suppliers. Allgemeinen It costs less than the patient to use suppliers network.






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