What is Health Insurance?

 Health Insurance is a good way to help you manage your health care costs,in Other words this is a financial
agreement for the payment of health care products

-In simple terms, a mediclaim policy shall cover your medical expenses during hospitalization such as surgical procedures
,hospital stays,scan etc.

4 common types of health insurance

 HMO: Health Maintenance Organization
 HMOs often provide integrated care and focus on prevention and wellness. With HMO plans you must
choose an in-network primary care physician (PCP), and then all of your care will be coordinated
through that PCP to other in-network providers. So, if you need a specialist, such as a cardiologist (heart
doctor), you’ll need a referral from your PCP first. Though, some HMO’s do not require a referral to see
a specialist.  HMOs do NOT cover any out-of-network healthcare costs, except in an emergency.
 EPO: Exclusive Provider Organization
 EPO Plans are more flexible than HMO plans in that you are typically able to see a specialist without a
referral. Though, some EPO plans require a referral to a specialist. Like HMO plans, EPO plans do NOT
cover any out-of-network healthcare costs, except in an emergency.
 Health Savings Account (HSA) Plans
 HSA plans give you the most control on how your healthcare dollars are spent. They tend to have lower
monthly premiums and higher deductibles. If you have a HSA Plan, sometimes referred to as a
High Deductible Health Plan (HDHP), you are able to set up a Health Savings Account, a type of
savings account that allows you to set aside money on a pre-tax basis to pay for qualified medical
expenses. This is important because with HSA plans, your insurance company doesn’t pay any of the
medical costs until the deductible is met, but by using the untaxed funds in an HSA to pay for these
expenses, you can reduce your overall healthcare costs.
3 Main Ideas of Health Inusrance

Premium. The amount paid for an insurance policy. Premiums can be paid by employers,
unions, employees or individuals or shared among different payers.

Deductible. The amount you must pay for covered care before your health insurance begins to
pay. Insurers apply and structure deductibles differently.

Out-of-Pocket Cost. Your expenses for medical care that are not reimbursed by insurance. These
include: deductibles, co-insurance, and co-payments for covered services in addition to all costs
for non-covered services.

2 types of expenses involved in health insurance

Covered benefits. The medical care items or services obtained by a subscriber that a health
insurance plan agrees to pay for, under certain terms and limitations. Covered benefits and
excluded services, and the terms and limitations of coverage, are defined in the health insurance
plan’s coverage documents or the subscriber contract.

Exclusions. Lists of specific medical items or services or general circumstance (e.g., not

medically necessary) in a subscriber contract that are not covered benefits.