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Benefits of Health Insurance to Individual and Families

Health insurance offers compensation to insurance companies when they encounter unexpected health problems and urgently need financial help. Health insurance covers most of the medical expenses necessary at the time of hospitalization, follow-up, diagnosis, counseling and various medical examinations. Health insurance agencies can be privately owned or they can be owned by non-profit foundations, but all of these organizations provide insurance policies for individuals or groups. Health insurance can be a company sponsored program for employees or an individual can even create a health insurance policy for himself and his dependents. Many developed countries provide health insurance assistance to the public through their government-sponsored programs, such as the US Media Program. The insured must pay some expenses to obtain coverage and benefits such as fees, discounts, fees, and some expenses. pocket-size.

The concept of health insurance was founded by Hugh the Elder Chamberlain in 1694 due to the frequent accidents that occurred. And he looks at how people have become physically disabled from accidents that they have had. Initially, health insurance was the claim paid when accidents occurred and medical treatment coverage was required. Health insurance was previously known as accident insurance. Some companies, such as the Franklin Health Assurance Company, worked at the time to submit claims to policyholders against rail, highway, or steamboat accidents. Health insurance companies have gradually introduced policies that cover patient costs, follow-up, diagnostics, and other medical checks. During 19202 many of these insurance companies began operating.

There are several health insurance concepts that a person should be aware of before creating an insurance policy. Everyone knows that health insurance is a contract between the insured and the insurance company. The insurance policies created can be long or short term.

The insured must pay a certain amount of fees for a future claim that can be monthly, quarterly or annually to receive future benefits known as “premium”. The insured must also pay a certain amount out of pocket up to a certain limit when they go to the clinic or undergo an examination, treatment or diagnosis before obtaining the benefits of their document, which is known as “tolerance“. The amount to be paid is determined by the company as a deductible at the time of signing the contract. The insured must also pay a certain amount each time he visits the clinic, known as a “copayment“, before obtaining insurance benefits. To process the insured’s dependents, the insured pays a certain fee known as “capitation.” Some companies deliver a document to the hospitals indicating that they will pay a certain amount as compensation to the insured, so the hospitals must attend to the patient taking into account the payment that is paid from the insurance company, which is known as “pre-authorization” . .

Benefits of Health Insurance to Individual and Families


Insurance plans can be comprehensive or scheduled. Comprehensive plans are a fixed percentage of fees paid to hospitals after discounts are paid by the patient. All-inclusive plans are paid for in a lump sum. Scheduled plans are plans that insurance companies pay to the insured to cover routine expenses related to hospital care, such as money for prescriptions, etc.

There are two main types of health insurance. One is fee for service and the other is managed care. The two policies are different from each other and also similar to each other. As part of the “service for payment” plan, the patient visits the doctor for other routine checkups or follow-up and sends the fees to be paid to the clinic. The medical services organization may also provide fees to pay for providing the service to the patient. Under Managed Healthcare there are three basic types of plans HMO, PPO, POS. There are several diagrams available for all three types of plans. These plans can be complete or scheduled.

Under the HMO plan, the insured has a wide choice of choosing their own doctor or medical organization. In most HMO plans, the insured must pay a certain amount of fees before using the service of the medical professional at each visit known as a “copayment.” Most of the costs are borne by the patient prior to receiving coverage, and the patient must also pay for lab tests. According to the PPO, the doctor is not a preplanner, the patient signs a contract with hospitals, and hospitals charge less than insurance providers. Some points should be considered before choosing the PPO network, such as the doctors who are covered by the PPO, the hospitals that presented the PPO plan, etc. In a POS plan, the doctor is selected from a network of providers covered by the POS plan. The insurance company will refer your doctor and you should only take advantage of their company’s services.

Today, many US residents choose a short-term insurance policy. Between $ 1 million and $ 2 million are spent on short-term policies. Short-term policies are renewable and more flexible. The duration of the policy varies from one month to twelve months. Long-term policies also provide many benefits and cover many costs, but they are expensive. Therefore, many people prefer to buy a short-term policy.

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