Understanding Your Health Insurance Policy
Nowadays people are not only scared of the tragic situations, but afraid of terror attacks and dieses that can harm them in healthy manner. That has a lead to the rise of health insurance companies and it is very necessary now to have own individual health policy. It is also as a tough task to select the insurance policy according to the needs, for that there are many policies available which may have the same requirements which you need. First of all you need to understand the basic laws and functions of the health insurance and then find out the best suitable plan for your requirements. Health insurance plans are sometimes very difficult and complex to understand, so finding a suitable policy is one of the toughest tasks in our hands. It is advised that you should concern a legal authority before having an insurance policy.
Categories of health insurance
There are many kinds of health insurance, but they are classified in groups and categories. Many people consider that if they get benefitted from the health insurance then they have utilized their services properly and their money has been utilized but if they are benefitted then they think there has been wasted in the insurance policy. There are few conditions and regulations of health insurance. You need to calmly decide the insurance policy without any stress, as it will complete the health problems and some are given below:
- Insurance policy that covers the how many diseases, generally policy have an inclusion and exclusion list of diseases, that are covered under the policy, for that you know need to get all the information and avoid the later confusions. Better read the documents and terms in calm mind so that in future you won’t feel cheated and you may get the full benefit of policy.
- Remember those diseases which are not covered under the policy, and consult the exclusion list of diseases provided by the insurance policy that would be beneficial for you in future claiming. Then you must be prepared that there will be no reimbursement for those illnesses by the insurance policy and all the expenses would be paid by insurance holder.
- Always read the terms and validity of the insurance policy, as generally people take insurance policy and tend to forget the renewing of the policy before expiry date. Every insurance policy has a valid term and regulation after that they are null and void and there would be coverage for illnesses.
- Also check that if incase you lose a job or you get transferred then is your policy valid or not as many companies provide their own health insurance to their employees. In case you have changed you job then better be insured and get the maximum benefits according to the insurance portability and accountability act (HIPAA) of 1996.
Better understand your policy
Always try to understand the policy you are taking form the health insurance company as they deny the payments for medical services. It is because of one simple reason that is the consumer’s are not following the rules and regulations of the health policies and they tend to demand for those coverage which doesn’t comes under the coverage policy. There are some common mistakes which a common man does while taking a policy:
- The consumer thinks he would be paid for the visit of the doctors. The health plan generally doesn’t pay any liable amount as they are considered as primary care.
- If the PPO participants visit a doctor within the network of the PPO, then he would be paid 80% but if he is out the circle then he must be paid 20 %. This thing also creates misunderstanding between the insurance policy and the consumer.
- A heart consumer gets done surgery without any prior information is bound to have the surgery cover and it would be fully covered by the consumer alone but if it is pre-authorized then the insurance policy covers up the full surgery.
- If a consumer appeals for the health plan and the insurance plans deny then there must be some consumer related problem or there must be the lack of the internal appealing. In order to avoid these mistakes you must read the full documents before taking a health insurance policy.
Some useful words in the insurance World
Health insurance is the growing industry nowadays; it has provided many benefits and the safety and security to the people after they are dead. It is better to have to have an insurance policy before its get too late; basically there are many insurance words that are used in the field of health insurance that are:
- Deductable: It commonly refers to the amount of money that is paid by the consumer before utilizing the benefits of the health insurance. This amount is paid generally once a year and after that the deductable amount is applicable next year. There are some services that are not deductable such as a visit to the doctors; usually there are different type’s deductable amounts according to the family members
- Co-insurance: it is referred as the amount of the insurance responsible for claiming. It is generally split in 80/20 that means the company will pay 80 % of the procedure and the rest 20% would be paid by the consumers.
- Co-payments: the co-payments are the fixed amount for the consumer that has to be paid at the time of taking the policy. It is basically taking for the doctors’ visit and their prescriptions and other medical advices.
- Out of pocket: this is one of the amounts which are paid by the consumer, and it is not even referred how much it can be and the term is referred as the annual out the pocket, excluding premiums and other benefits. They have to be managed by the consumer itself only.
- Lifetime maximum: it is the most efficient part of the health insurance company as it covers the entire life, and pays attention to the individual for different diseases at different time of the life.