Understanding Health Coverage Basics

Understanding Health Coverage Basics

Obtaining Healthcare Coverage is not always as easy as one thinks!

For those who do not have group coverage, selecting the right health plan can often times become complex and frustrating. This site is dedicated to those who require some background information so that they can make the right choice. Often times just understanding the terminology used by health plan providers can also lead to confusion. This site will also provide a basic understanding to terminology most used by carriers and health sales agents.
The following basics should be understood before making any decision regarding your health plan purchase.

  • Providers
  • Understanding Plan Types
  • Understanding Coverage Types
  • Understanding Basic Terminology most used carriers and their agents
  • What questions should you ask yourself prior to making a decision
  • Are there additional links to assist you in obtaining the information you need

Health Insurance Providers - a number of sources are available for individuals seeking health insurance protection. For the most part, health insurance providers can be divided into three main categories: commercial, service providers and the state or federal government. The main objective is to provide protection against any financial costs that come with illness, injury or disability.

Commercial Insurance Providers:

Health insurance can be written by many providers including, life insurance companies, casualty insurance companies, and single line companies that specialize in one or more types of medical expense and disability income insurance. This includes both individual and group policies.

The basic concept behind commercial insurance companies is that they operate on the reimbursement approach. which in plain English means: You receive treatment, charges are submitted to your provider and then you are reimbursed for these expenses, with the only difference being that you have what is called ''the right of assignment'' built in so that these reimbursed payments go directly to the healthcare provider and not to you.

Service Providers:

With service providers there is a different approach. With this approach a monthly premium is charged and as a result of this monthly payment you receive the benefits as services provided by the hospitals and doctors provided in the plan.
HMO''s and PPO''s are examples of this type of provider.

State and Federal providers:

Is protection provided by a state or federal government program. Examples of these are: Medicare, Medicaid, Social Security Disability and State workers, compensation programs.

Alternative Method Providers:

In addition to the above three types of providers there is what''s called ''alternative methods of providing health insurance''. An example of this is called Self Insurance. For businesses and individuals this an alternative to commercial or service health insurance plans. These can be diverse but the many of these plans are administered by insurance companies that are paid a fee for handling the paperwork and processing the claims. When an outside organization or insurance carrier is involved in providing these functions it is called ASO (administrative services only) or TPA (third party administrator.

It is important to remember, regardless of your needs and budget, maintaining some form of health coverage is vital. Age, health conditions, pre-existing conditions, and finances, all contribute to making a wise choice, but being without any type of coverage can often times become a financial catastrophe.