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Health Insurance Information

Health Insurance

 Health insurance is a type of insurance that pays for medical expenses in exchange for premiums.
The way it works is that you pay your monthly or annual premium and the insurance policy
contracts healthcare providers and hospitals to provide benefits to its members at a discounted rate.
This is how hospitals and healthcare providers get listed in your insurance provider booklet.
They have agreed to provide you with healthcare at the specified cost.
These costs include medical exams, drugs and treatments referred to as "covered services" in your insurance policy.  

As with any type of insurance, there are exclusions and limitations. If you elect to have a medical procedure
done that is not covered by your insurance, you will have to pay for that service
out of pocket.

Additional Costs
Aside from premiums, there are other costs associated with your health insurance coverage.

Premiums: This is the amount that you pay for coverage.

The amount that you pay out of pocket. Like any other type of insurance,
deductible can range in amount depending on how much you would like to pay out of pocket.
Generally, the higher the deductible, the lower the premiums.

Co-insurance: The percentage of covered expenses paid by the medical plan.
For example, in a co-insurance arrangement, there can be an 80/20 split between the insured and
the insurance carrier in which the insured pays 20% of the cost of care up to the deductible,
but below the out-of-pocket limit set forth by the policy.
This is typically associated with coverage provided by a PPO.

Co-payment:  Sometimes referred to "
co-pay", this is a set cap amount that you will pay each time you receive medical services.
For example, every time you visit your doctor, you may have to pay $20 as a co-payment.
These payments usually do not contribute toward out-of-pocket policy maximums.

Out Of Pocket Maximum: The cumulative dollar amount of covered expenses in excess of the deductible
after which the coinsurance payment stops and the insurer pays 100% of covered expenses.
The purpose of to the stop-loss limit is to limit the out-of-pocket costs for the insured individual. 
The "out-of-pocket max" is the maximum out-of-pocket expense you will incur before your insurance carrier
pays 100% of covered services. At this point, all you will have to pay is your premiums. 

Types of Plans

Indemnity Plan

An indemnity plan, sometimes called a fee-for-service plan, is a type of insurance that reimburses you according
to a schedule for medical expenses, regardless of who provides the service.
Under these plans, the insurer pays a specific amount.
The amount paid can be calculated either as a percentage (80/20) or for actual expenses.

Health Maintenance Organizations (HMO). HMOs provide a wide range of comprehensive
healthcare services
to a group of subscribers in return for a fixed periodic payment. With this type of coverage,
you select a primary care physician that acts as the
gatekeeper for you to receive virtually all the medical care required during a year.

Preferred Provider Organization (PPO)
PPOs are a group of healthcare providers that contract with an insurance company, third-party administrators,
or others (like employers) to provide medical care services at a reduced fee.

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