Health insurance

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 Health insurance
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 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 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 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_insuran
ce_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.
 Contents
Health insurance:......................................................................................2
What are the different types of health insurance?..................................2
What are health maintenance organizations (HMOs)?.........................3
What are exclusive provider organizations (EPOs)?..............................3
What is a point of service plan (POS)?...................................................3
What are preferred provider organizations (PPOs)?.............................4