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Health Insurance Basics For Persons Looking For Policies

By April Heath


There are several ways in which one can get a health policy. Most people get insurance services through their employers. Others prefer looking for their own. When buying the policies as a group, the main advantage is that the services are cheaper. To be able to make a good decision regarding which policy to take, it is important to be aware of a few health insurance basics.

Before getting a policy, one must make a commitment to make regular payments to the insurer. These payments are known as premiums. Usually, the amount of premium paid is equivalent to the extent of cover that will be provided. The premium will be used to take care of expenses related to the medical conditions or diseases specified in the policy.

Health insurance plans are usually organised as networks of hospitals, clinics, doctors, consultants and other specialists. The service providers enter into a contract with the insurer. Under the agreement, healthcare providers have to provide a given set of services to the insured clients on behalf of the insurance company at a certain fee which is often subsidized. Individuals seeking services from out of network doctors have to pay for them using other means.

There are various insurance plans in current use. One of them is that which is provided by health maintenance organisations or HMOs. HMOs only work with doctors who have signed a contract with the provider of the cover. Out of network services may only be used in emergency situations. The insured persons are usually individuals who work or live in the service areas of the HMO. Although they provide integrated care, their main focus is health promotion and prevention of diseases.

Preferred provider organisations, PPOs allow the insured individual to seek services both within the network and outside. The cost of the services is a little cheaper if sought from the contracted providers. Policy holders are required to yearly deductibles before the insurer starts paying their bills. In most cases, the insurer agrees to pay a certain fraction of the bills depending on the agreement. A third type, Point-of-service (POS) has aspects of both PPOs and HMOs.

Before making any commitments, it is important to find out what the package in a policy contains. The best policy is one in which a wide range of specialities are provided. There should be specialities qualified to deal with problems such as oncology, cardiology, pathology, gastroenterology and surgery among others. Visiting the listed hospitals beforehand will help create a clearer picture of the actual situation.

There are many products in the market packaged as comprehensive medical cover but are actually very different from what they are said to be. These include, among others, accident-only policies, dreaded diseases policies and supplemental policies. These policies are limited in their coverage of health conditions. For example, the dread disease policy will only pay for services related to specific diseases such as cancers and no other.

The amount of premium that the insured party contributes should as much as possible be reflected in the quality of care provided. Persons seeking policies should not rush to buy the cheapest. The cheap policies may end up being quite expensive in the long run as clients will have to pay for most services themselves. Knowing the health insurance basics will greatly help decision making in this area.




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