Health Insurance | Medical Insurance |
The term health insurance is generally used to describe a form of insurance that pays for medical expenses. It is sometimes used more broadly to include insurance covering disability or long-term nursing or custodial care needs.
Comprehensive Health Insurance vs. Scheduled Health Insurance
Comprehensive health insurance pays a percentage of the cost of hospital and
physician charges after a deductible or a co-pay is met by the insured. These plans are
generally potential benefit payout one to five million.
Scheduled health insurance plans are not meant to replace traditional
comprehensive health insurance plans. This type of health insurance is a basic policy
providing access to day-to-day health care such as going to the doctor or getting a
prescription drug. They generally pay limited benefits amounts directly to the service
provider. Annual benefits maximums for a typical scheduled health insurance plan are
$1,000 to $25,000.
Important Definitions That You Should Understand When Shopping Health Insurance
Deductible: The amount that the patient must pay before the health insurance plan
begins to pay its share. For example, a patient might have a $1000 deductible per year,
which means that the patient must pay the first $1000 in medical expenses per year.
Copayment: The amount that the patient must pay at each visit or service with a
doctor. For example, a patient might pay a $45 copayment for a doctor's visit, or to
obtain a prescription. A copayment must be paid each time a particular service is
obtained.
Coinsurance: The alternative to a Copayment is coinsurance, the patient is
responsible for a percentage of the total cost. For example, the member might have to
pay 20% of the cost of a surgery. So, if the surgery cost $10,000, the patient would
pay $2000.
Premium: The amount the patient pays to the health insurance company each month
for the medical coverage.
Exclusions: The patient is expected to pay the full cost of service that are
exclusions.
Out-of-pocket maximums: Similar to coverage limits, except that in this case, the
member's payment obligation ends when they reach the out-of-pocket maximum, and the
health plan pays all further covered costs.
Coverage limits: Health insurance plans typically only pay for medical care up to
a certain dollar amount per year and/or over the lifetime of the coverage.
In-Network Provider: A health care provider on a list of providers preselected by
the health insurance company. The health insurance company will offer discounted
copayments or coinsurance, or additional benefits, to see an in-network health care
provider. Providers in network are providers who have a contract with the health
insurance company to accept discounted rates.
Capitation: An amount paid by an insurer to a health care provider, for which the
provider agrees to treat all members of the insurer.
Prescription Drug Plan: This type of plan allows patients to make a copayment for
prescription drugs.
Amerisave and all affiliated companies make no warranty and take no responsibility for
the accuracy of the information found on this website. All information should be
verified with your insurance carrier.
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