Health Insurance Frequently Asked Questions

What is managed care?

It is a health-care system in which your primary physician plays the role of the gatekeeper for other specialized medical services. It is divided into three main types.

Preferred Provider Organization (PPO): The network is the main concept behind a PPO. You may choose any health care provider within your network as determined by your policy or other health care provider outside your network if you choose this type of insurance. A co-payment or payment for co-insurance is usually required. You can save a lot by staying in-network with PPO.
Health Maintenance Organization (HMO): You are also required to make a co-payment to an in-network physician by the HMO. The difference between a PPO and HMO is an HMO does not pay for services which are received outside the network. The gatekeeper to your health care is acted by your primary care physician and you must be referred by them in order to get specialty care.
Point of Service (POS or Open Access HMO): This is similar to HMO but you can go out of network with this plan. You are usually being reimbursed for 50 to 80% with the plan and a co-insurance and deductible payment may be required.

Is health-care system only contains managed care?

The health insurance cost has greatly increased over the last decade. Therefore, Health Savings Account (HSA), a consumer-driven health-care system is being created. This plan pairs with a High Deductible Health Plan (HDHP).

Money which is tax-exempt is put into savings account by the health-care consumer. They use the money to pay when they need medical care. If the deductible of their HDHP is lesser than the cost of service, the excess will be paid by the insurance company.

This plan helps you to save money because you are required to pay only if care is sought by you. However, if you have accident-prone children or health condition, this policy may cause you a lot.

What is an out-of-pocket limit?

After you pay certain amount of money for covered medical services which include your co-payments and deductibles, the remainder of your medical expenses for the rest the year is paid by your insurance company.

What is a lifetime maximum?

It only pays certain amount for medical care received throughout your whole life. Depending on your plan, the amount will vary. This is essential for you to know if you or a family member is an ongoing medical condition sufferer.

What are exclusions and limitations?

Some services may not be included in your policy such as cosmetic dentistry or mental health care. Some items also have their limits, for example, the duration of you staying in hospital. You will take upon the things excluded or limited by your plan.

How often do rates change and will they increase as I age?

As you get older, you will be at a higher risk to develop health problems. Health related statistics are being considered by insurance underwriters. You should ask questions and understand the way they determine your health ranking for a better price. Some health conditions do not necessary increase your rates.

Is my prescription being paid by health insurance?

Most of the time, a co-payment is made for prescriptions. Some prescriptions may not be covered like oral contraceptives or hormone replacements. It all depends on your plan.

Is there any waiting period before certain treatments are covered?

It depends on your policy. Some do have waiting periods before they pay for your health care while others have waiting periods before treatment for pre-existing conditions can be received.

Equip yourself with the relevant knowledge to get on the right track to right health insurance. What you should do now is to get insurance quotes just by filling out an application!

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