Health Insurance Logically Explained
May 13, 2008 – 12:40 pmHealth insurance is an insurance that can be used to pay for a person’s medical expenses in the case of an accident or illness. Health insurance is purchased as premiums. A person can purchase insurance sponsored by the government as social insurance, or receive insurance from a private company. Plans can be purchased by individuals or in groups, such as when company’s use insurance as benefits for the employees. Health insurance prices are estimated by the likely hood an insurance holder has to be in need of medical help. For example a healthy young insurance holder will probably pay less for insurance than an older or sicker insurance holder.
Health insurance was founded by a man named Hugh Chamberlen in 1694. Health insurance was originally called accident insurance. It was run similarly to today’s disability insurance.
Health insurance works by a person buying a policy from the insurance company. A policy is the contract agreed upon by the insurance company and the policy holder. The contract can be paid for monthly or annually. The amount paid by the insurance holder to the company is called the premium.
Health insurance works by the insurance company selling a policy to the insurance holder. A policy is a contract between the individual and the company stipulating the size and cost of the plan. This contract is renewed either annually or monthly. The amount the policy holder owes to the insurance company annually or each month is called the premium.
All policies have limits and exclusions. Not all services are covered by the insurance company. If a situation in which a medical expense is not covered the policy holder will be forced to pay the bill with their own money. When the medical expenses of the policy holder surpass the amount agreed upon in the policy the holder will be forced to pay the remainder of the bill.
All policies have exclusions and limits. Not all services are covered by the insurance company. If a situation occurs in which the medical expenses are not covered the insurance holder will be forced to pay the entirety of the bill out of pocket. When the medical expenses of the insurance holder exceed the amount agreed upon in the policy the holder will be forced to pay the remainder of the bill.
Maximums that are basically the opposite of coverage limits are referred to as out-of-pocket maximums. These maximums are the amount that the policy holder is allowed to pay on their own. After this limit has been exceeded the obligation that the insurance holder has to the company stops. Capitation is the amount of money paid by the insurance company to the provider of the healthcare. In-network providers are healthcare providers that are found on a list that was made by the insurance company. If the policy holder uses one of the providers on the list they can receive discounts or extra benefits.
Moral hazard is a problem faced by insurance companies and policy holders everywhere. Moral hazard occurs when the healthcare provider and the insurance holder agree to tests that are deemed unnecessary by the insurance company. Most of the time the insurance company is still forced to pay for the expenses but this can cause problems between the company and the insurance holder in the future.
Tags: Insurance
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