There are lots of different kinds of health insurance,
from plans that cover medical services and prescription medicines to plans
that cover dental expenses; disability insurance that replaces income
lost due to extended illness or injury to long-term care, and so on.
"In the United States, people typically refer to
the plans that cover medical expenses as 'health insurance,' and these
plans are usually bought by employers and offered to employees as part
of their compensation, or 'benefits,' "says Kurt Stammberger, vice
president of marketing for Healthia, a company that provides comparison
shopping information for health insurance.
Health insurance plans are usually sold once, then renewed
on an annual basis. So when a consumer buys health insurance (either directly
or through an employer), the insurer agrees to pay for health expenses
as long as the premiums are paid on time and the account is in good standing.
Health insurance plans come in two flavors: "fee-for-service"
or "managed care". Both types of insurance cover major medical,
surgical and hospital expenses, and are often referred to as "major
medical plans."
Fee-for-service plans to pay the medical service provider
a fee, for each service provided to a patient, and that patient can usually
go to see whatever health care provides they wish. Managed care plans,
on the other hand, pre-pay contracted providers for each member's coverage
in advance. Members are offered a financial incentive to use providers
who belong to the plan.
Here are a few common terms that you'll probably run
into:
Deductible - This is the amount you must pay out-of-pocket before the
insurer will pay anything. Deductibles can vary widely, ranging from nothing
to a few thousand dollars.
Co-insurance amount - This is the percentage of your
medical expenses you must pay after you reach your deductible. This will
typically range from 10 percent to 30 percent.
Maximum out-of-pocket amount - This is a maximum amount
you are required to pay in a given year, after which the insurer will
pay 100 percent of the cost of covered medical expenses.
Covered benefits - Types of medical services the insurer will pay for.
Exclusions - Types of medical services the insurer will
not pay for.