Health Insurance- Types, Plans And Benefits

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What is Health Insurance


Health insurance is a type of insurance that covers expense of health care ( whether medical or surgical expenses) of the insured. Health insurance is also known as medical insurance or medicare. It protects the insured from paying full expense when they are sick or injured. An insured is an individual who pays a particular sum of money each month or year for the health cover. For example, if you are sick and your medical expense is $100, your health insurer has the responsibility to pay some percentage, let’s say 30% ($30) of the total bill depending on the agreement between the insurer and you.

The insurer can be a clinic, a hospital, a doctor, a laboratory, a pharmacy or health occupation.

What are The Types Of Health Insurance?

 There are basically two types of health Insurance. They are Private health insurance and government or public health insurance. The first one is attained through private insurer and the latter can be attained through the government.


Types of health Insurance Plans

  • Preferred Provider Organization (PPO)
  • Health Maintenance Organization (HMO
  • Point of Service (POS)
  • Exclusive Provider Organization (EPO)
  • Indemnity Plans

1. Preferred Provider Organization (PPO) Health Insurance Plans
A PPO plan which is known as Preferred Provider Organization is a health plan that encourages members to use a network of preferred doctors and hospitals.

These insurers are contracted to provide service to plan members at a negotiated or discounted rate. In this type of plan, you will pay more if you see out-of-network doctors rather than in-network doctors.

A PPO may be a good option for you if you want freedom when choosing doctors and other health care providers.

2. Health Maintenance Organization (HMO) Health Insurance Plans
An HMO delivers all health services through a network of healthcare providers and facilities. In HMO plan you have less freedom in choosing your health care providers. A primary health doctor is assigned to you, to manage your health care and also refer you to specialists when you require one.

In HMO’s network, If you see a doctor who is not in the network without proper authorizations from your Primary Care Physican (PCP), you’ll have to pay the full bill yourself.

3. Point of Service (POS) Health Insurance Plans

This health plan combines the features of HMO and PPO plan.In this plan you have more freedom to choose your care providers than you would in an HMO plan. You can see out-of-network providers but you’ll pay more. Just like an HMO, POS plans may require you to choose a Primary Care Physician (PCP) from the plan’s network providers.

If you use covered services that are offered or referred by your PCP you may receive the higher level of coverage. If you use services by out-of-network provider, you may be subject to a lower level of coverage.
A POS may be a good option for you if you want freedom when choosing physicians and other providers.


4 Exclusive Provider Organization (EPOs) Health Insurance Plans

EPO is similar to HMO plan but in EPO plan, you may have the freedom to choose your health care providers than in HMO. You do not have to get a referral from a primary care doctor to see a specialist. There is no coverage for you if you see out-of-network providers except in an emergency.

An EPO may be a good option for you if you can afford potentially higher costs for unplanned events.

5. Indemnity Health Insurance Plans
Indemnity health plans are also known as Fee-for-Service plans due to its pre-determined amounts or percentages of costs paid to the insured for covered services.
In most cases the member will pay first out of pocket and then file a claim to be paid for the expense.
An Indemnity Plan may be a good option for you if you seek high levels of freedom and choice for doctors and hospitals.

Benefits Health Insurance
1. Ambulatory Patient Services- This is the kind you get without being hospitalized.

2. Hospitalization

3. Emergency care

4.Preventive and Wellness Services counseling, screenings, and vaccines to keep you healthy and care for managing a chronic disease.

5. Maternity and Newborn Care services.

6. Laboratory services

7. Drugs prescription

8. Rehabilitative and Habilitative Services.

9. Mental health care services.
10. Pediatric services: This includes dental care and vision care for kids.


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