A health insurance plan is a legal contract between an individual and an insurance company. The health policy helps cover medical expenses for health treatment as dictated by sickness or accidental bodily injury. The level and type of healthcare covered is outlined in the health plan or Evidence of Coverage booklet. Here are some important terms to know about your health insurance plan coverage:
- Coinsurance: unlike an upfront fixed copayment, you pay a percentage of the total medical costs. Your portion of the medical costs in terms of percentage of costs is outlined in the health policy
- Copayment: fixed amount you must pay out of pocket before the health insurance company pays for a health service or prescription
- Coverage Limits: some healthcare plans offer coverage up to a certain dollar amount and thereafter, you have to pay for the expenses
- Deductible: your out-of-pocket amount before the insurance plan pays for the rest
- Exclusions: health services that aren’t covered by insurance. Excluded medical care expenses have to be paid out of pocket by you
- Out-Of-Pocket Maximums: the opposite of coverage limits except that in this case, your obligations ends when the out-of-pocket maximum is reached, and the health insurance company pays all additional covered costs
- Premium: your regular payment for maintaining your health insurance coverage
Choosing the right health insurance company and plan involves understanding various facets. Regrettably, there isn’t anything that resembles standard health coverage, depth and breadth of coverage varies enormously from one plan to another and from one company to another.
Many times the lowest premium is not necessarily the best plan with the most benefits. You want a plan that covers the health services you desire and need for competitive cost. Fundamentally, differences between health insurance plans come down to three entwined elements: costs, benefits, and restrictions.
The cost varies with the plan you choose, your regular premium payments are the primary costs associated with your health coverage. Also, costs vary with coinsurance, in-network and out-of-network services, deductibles, exclusions, coverage limits, and more.
Virtually every health insurance plan will provide coverage for physician services and hospital bills, with an assortment of limits. Certain benefits such as, glasses, psychotherapy, preventive care, prescription drugs, immunizations, and screenings may or may not be covered under your plan.
Restrictions and Regulations
Usually, managed-care plans limit your choice of health providers and necessitate pre-approval for services. Also, some health insurance policies come with limitations in the form of co-payments, deductibles, and uncovered services. The lack of freedom of choice in physician care is another roadblock in managed healthcare plans.
Your decision to acquire the right health insurance also involves choosing the insurance company. Here are some things you can do to choose the right company:
- Research the company offering you the insurance
- Find out the company’s credit rating by rating firms like a.m. best
- Ask the insurance company agent or representative questions, as needed
- Make sure you understand what the policy will pay for and what it won't
- Find out the different types of policies the company offers
- Discover what is covered or not under your plan
Additionally, here is a list of some of the most popular health insurance companies:
- Alliance Health and Life Insurance Company
- Altius One
- Anthem Blue Cross and Blue Shield
- Blue Cross and Blue Shield
- Coventry Health Care
- Golden Rule
- Great-West Healthcare
- Group Health Plan
- Health Partners
- Kaiser Permanente
- KPS Health Plans
- State Farm
- United Healthcare
- WellPath Selec
- Zurich North America
The decision to get health insurance is one of the most important decisions you can make. It involves evaluating the various health plans and the health insurance companies.