Before knowing the health insurance companies definition, people should understand first about the health insurance. Health insurance is one of the insurances which cover all the cost of someone’s medical and surgical expenses. There are two types of health insurance coverage. You may choose to pay out-of-pocket and then you reimburse or the insured pays directly to the provider. The provider, in health insurance means the hospital, clinic, doctor, health care practitioner, pharmacy or laboratory. While the insured, in this terminology, is the health insurance owner or the person who has the health insurance coverage. In the countries which don’t belong to universal health coverage, just like in USA, the health insurance generally included in the packages of employer benefit and can be seen as employment bonus.
Does health insurance cover a human right or another product?
In several countries, for example in United Kingdom or Canada, the coverage of health care is given by the state and it is one of the citizen’s rights. It is categorized into public education, firefighters, police, street lighting, and public road networks. Those are part of public service for nation. However, in some other countries, for example in USA, the coverage of health insurance is rather different. The insurance is the individuals’ responsibility except for some groups such as disabled or elderly people, veteran, and also some others. Recently, the Obama Administration introduces the laws which make it a mandatory for everybody to have health insurance. Moreover, there are penalties for those who refuse to have the insurance. The health insurance companies definition here accommodate everybody to get the medical attention and treatment. Everybody, some time in their life, may need medical treatment. When they need it, the patient should concentrate to get better. They should not wonder about the bills. This view now become more general held in all the developed nations that thinking about the health is the most important thing rather than thinking about how to pay the medical bills.
Two general types of health insurance
There are two general types of health insurance. First is the private health insurance. The CDC or Centers for Disease Control and Prevention says that the health care system in US is really depended on the private health insurance. More than half percentages of American choose private health insurance. The second one is public or government health insurance. For this insurance, they need to collect the premiums, although the insurance is paid by the state. The National Health (NHS) in United Kingdom is not the kind of health insurance, but it provides medical services freely for the citizen. There is no premium being collected. However, this is what we called universal health insurance. The example of health insurance companies definition in USA is Medicare. It is a social insurance as the national program for people who aged 65+ years old and also for disabled people. In addition, there is Medicaid which got the fund from government and individual states. SCHIP is the health insurance company which is for children and families who cannot pay for the private insurance but doesn’t belong to Medicaid qualifications. There are more public health insurance in USA such as the Veteran Health Administration, the Indian Health Service and TRICARE.
The five types of health insurance plans in the USA
There are at least five types of health insurance plans. They are indemnity plans, health maintenance organization at the end, point of service plans, preferred provider organizations, and combination plans. All of them typically are considered as the managed care plan. The US Congress told a new choice the Health Savings Account in 2003. This new option is the combination of all the five plans and a saving account which has tax-benefits. It is so useful and absolutely important to understand the difference aboul all the plan types. By knowing them really well, then you can consider to choose one for you, your family or your employees. However, the plans develop and there are addition details and subtraction on other ways. Sometimes there is overlap and some progressions are blurred. Most of fee-for-service plans or we called it indemnity plans apply the managed care techniques. They use the techniques to manage the costs and make sure there are resources to pay the care. Some health insurance companies definition also adopt the characteristics of fee-for-service.
What are managed care plans?
Managed care plans are the plans of health insurance which provide the contract with the health care providers and medical facilities. This will treat medical care with lower prices. The providers here form the plan’s network for you to choose. The network rules require on how much care plan the one should pay. Restricted plans normally cost cheaper to the insured, while flexible plans are pricier. For HMOs, you only need to pay only for care when you use one provider in the network. They provide general care doctor to take care most of the patient. However, PPOs will cover the cost more when the insured chooses a provider in their network, and they also pay money for outside network providers. In addition, POS plans permit the insured to select between HMO and PPO when the insured needs medical care.
What are Indemnity Plans?
The insured has the right to select the doctor they want. The hospital, doctor or the insured should collect the claim for reimbursement to the health insurance company. That’s what health insurance companies definition for. It is essential to remember, just like other insurance plan, that the insured is able to reimburse only the listed and mentioned in the Benefit Summary. So you should read carefully and understand all the lists printed. Even the footprint or small print, and ask if you have questions before signing it. Most indemnity plan says that they cover all the vast majority of procedures.
What are HMOs (Health Maintenance Organizations)?
HMOs provide medical care straightforwardly to the insured. When the insured need medical attention, the insured can go directly to the HMO’s medical provider. The insured doesn’t need to pay for the service she/he received. The premium set will be paid to the HMO and return some offers including preventive care. That’s one of the health insurance companies definition for handling the health insurance coverage.