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    Esra Aljabri
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    Health insurance provides coverage for medical costs and helps pay for healthcare services. It exists in most countries as not everyone can afford direct medical costs without financial risks. Health insurance types include HMOs, EPOs, POS plans, and PPOs. HMOs require choosing providers from a local network and a primary care physician. EPOs also require choosing from a network but may not cover out-of-network care. POS plans combine features of HMOs and PPOs with a smaller network and lower costs than PPOs. PPOs offer larger networks but you pay more for out-of-network providers. A health insurance policy would normally cover expenses like hospital rooms, medical care, surgery, and diagnostic tests

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    Health insurance provides coverage for medical costs and helps pay for healthcare services. It exists in most countries as not everyone can afford direct medical costs without financial risks. Health insurance types include HMOs, EPOs, POS plans, and PPOs. HMOs require choosing providers from a local network and a primary care physician. EPOs also require choosing from a network but may not cover out-of-network care. POS plans combine features of HMOs and PPOs with a smaller network and lower costs than PPOs. PPOs offer larger networks but you pay more for out-of-network providers. A health insurance policy would normally cover expenses like hospital rooms, medical care, surgery, and diagnostic tests

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    6 views7 pages

    Health Insurance 2

    Uploaded by

    Esra Aljabri
    Health insurance provides coverage for medical costs and helps pay for healthcare services. It exists in most countries as not everyone can afford direct medical costs without financial risks. Health insurance types include HMOs, EPOs, POS plans, and PPOs. HMOs require choosing providers from a local network and a primary care physician. EPOs also require choosing from a network but may not cover out-of-network care. POS plans combine features of HMOs and PPOs with a smaller network and lower costs than PPOs. PPOs offer larger networks but you pay more for out-of-network providers. A health insurance policy would normally cover expenses like hospital rooms, medical care, surgery, and diagnostic tests

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    of 7

    Healthinsurance

    Esra aljabri
    Health insurance:
    which is coverage against the risk of incurring medical and
    related financial costs, is one of the ways that people in
    various countries pay for their medical needs. In every
    country, there are people who are unable to pay directly or
    out of pocket for the healthcare services they need, or
    financially they may be seriously disadvantaged by doing so. In
    lower-income countries, many forms of health insurance –
    whether public or private –cover only a minimum set of
    services, such that they do not provide full financial risk
    protection.
    What are the different types of health insurance?

    -The different types of health insurance, include:


    -Health maintenance organizations (HMOs)
    -Exclusive provider organizations (EPOs)
    -Point-of-service (POS) plans
    -Preferred provider organizations (PPOs
    What are exclusive provider organizations (EPOs)?
    An EPO offers you a network of participating
    providers to choose from. Most EPO plans do not
    include coverage for out-of-network care except in
    the case of an emergency. This means that if you
    visit a provider or facility outside the plan’s local
    network, you will likely have to pay the full cost of
    services yourself.
    Depending on the plan, you may or may not be
    required to choose a primary care provider (PCP). If
    you want to see a specialist in your network, you
    don’t need a referral from a PCP.
    What are health maintenance organizations (HMOs)?
    HMOs give you a local network of participating doctors,
    hospitals, and other health care professionals and
    facilities that you are required to choose from. These
    types of health insurance plans also require you to
    choose a primary care provider (PCP) from the network.
    The costs for an HMO plan—copays and coinsurance--
    are typically lower than other types of health plans, as
    long as you stay in-network.
    What is a point of service plan (POS)?
    Point of service plans combine features of HMO
    and PPO plans. The provider network is typically
    smaller than a PPO plan and the costs for in-
    network care are typically lower, like an HMO.
    POS plans also require you to choose a primary
    care provider (PCP) from within the plan’s
    network of doctors and other primary care
    professionals. Your PCP is your home base for care
    and advice. They get to know you and your health
    needs and can help coordinate all your care.
    What are preferred provider organizations (PPOs)?
    PPOs typically offer you a large network of participating
    providers so you have a lot of doctors, hospitals, and other
    health care professionals and facilities to choose from. You
    may also choose to see providers from outside of the
    plan’s network, but you will pay more out-of-pocket.
    -What a Health Insurance policy would normally cover A
    Health Insurance Policy would normally cover expenses
    reasonably and necessarily incurred under the following
    heads in respect of each insured person subject to overall
    ceiling of sum insured (for all claims during one policy
    period).
    a) Room, Boarding expenses
    b) Nursing expenses
    c) Fees of surgeon , anesthetist , physician , consultants,
    specialists
    d) Anesthesia, blood, oxygen, operation theatre charges,
    surgical appliances, medicines, drugs, diagnostic materials,
    X-ray, Dialysis, chemotherapy, Radio therapy, cost of pace
    maker, Artificial limbs, cost or organs and similar expenses.
    References :
    https://www.nhp.gov.in/sites/default/files/pdf/health_insurance_handbook.pdf
    Ho, Anita. (2015). Health Insurance. 10.1007/978-3-319-05544-2_222-1.
    Rogers, M. A., Lee, J. M., Tipirneni, R., Banerjee, T., & Kim, C. (2018). Interruptions
    in private health insurance and outcomes in adults with type 1 diabetes: a
    longitudinal study. Health Affairs, 37(7), 1024-1032.

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