The cost of healthcare products and services goes on increasing these days. The obvious reason is the ongoing advancement in medical technology. Introduction of highly modernized machinery and newly improved drugs have raised the average life expectancy and if this trend persists, about 20 people out of 100 will be in the age group of sixty-five by the 2030. Naturally aged people require frequent medical care and services than do youth groups. They have to bear the high costs for health care expenses. This is the basis of acceptance and popularity of health insurance among the common mass.
What is Health Insurance?
Health insurance helps the insured to effectively manage their health care expenses in case of illness, injury or any other medical condition. Under an insurance policy, the insurer is required to pay a monthly or yearly premium and get medical services covered as specified under the benefits statement of the policy. This coverage may be available under a government agency or by private insurance companies.
Health care Benefits:
There are different health care policies that targets health coverage of different kinds. A schedule of benefits is enclosed with every health insurance policy. It mentions all the medical services which are considered to be medically necessary for the insured and should be covered by the insurer. Medical tests and procedure are carried out by the physicians to identify the abnormality and provide treatment for a particular illness or injury. Most of these medical services are in accordance with the existing professional medical standards.
On the way of reimbursement, insurers carefully examine every medical bill and confirm about the obligation of medical tests and procedures executed by physicians. They also verify whether medical services are performed following the rules and guidelines of reimbursement set by them.
Covered services are scheduled on the Benefits summary are the medical services which are covered by the insurer. These services cover medical treatment which may be inpatient, outpatient such as surgery or emergency, home health care and primary care. Preventive medical services are covered as part of primary insurance policies like Medicaid which provides for annual medical examination, immunizations, and prenatal care.
Uncovered services which can be certain medical procedures or services may be explained as part of the insurance policy. The policy may deny coverage for dental services, employment injuries, cosmetic procedures and eye examination. Some treatments or procedures are which could be alternatively handled or are not generally undertaken by patients such as skin transplants, weight loss surgery and experimental treatments for curing diseases. In case of pre-existing condition, i.e. if a person having a health policy has diagnosed a medical condition before the policy took effect, healthcare services to restore his health are not covered.
Getting health insurance, group and individual coverage
There are many health insurance plans today in the market. It is important to ascertain certain facts prior to choosing a proper health insurance. One can ask few questions like what benefits does the policy cover? Is it proper to your condition the services which are not covered? Does the policy targets your basic requirements according to your lifestyle and work conditions?
The insurance is available both at individual and group level. The group policies are relatively less expensive as compared to individual health policy. Group insurance is provided through employers or private/charitable organizations. A contract is signed between the health provider and the employee under whom medical coverage is provided under group health plan. Certain insurance policies cover the employees in case of termination or job change. Both group and individual plans cover primary care, preventive care and emergency care as part of the health plan.
Disability insurance and workers’ compensation
Specific insurance policies may provide insurance for special medical conditions such as disability. It insures the employee or a person with disability for the income losses that arise due to inability to perform job due to certain impairment. This is of type paid sick leave, disability benefits for both short term and long term.
Workers’ compensation is provided to an employee who suffers from on-job injury and is unable to work to earn a suitable income. It compensates the affected employee for lifetime including his/her incomes loss for time during service and post it. It also covers the dependents of the employees in case they die or go missing during employment.