Health insurance is a type of insurance coverage that pays for health and medical expenses. Health insurance covers some or all of the costs of routine care, emergency care, and treatment for chronic illnesses. In the United States, health insurance is often provided by employers as part of a benefits package, while Medicare and Medicaid provide retired and low-income citizens with health insurance coverage.
Health insurance companies charge their customers a monthly premium for coverage, and in exchange the company agrees to pay all or most of the person’s medical costs. Even under the most generous plans, insured people must pay various out-of-pocket expenses for medical care. Primarily these expenses include copays and deductibles, which are up-front costs paid by the insured to medical professionals before they receive services.
Health insurance plans fall into two broad categories: private insurance and public insurance. Private plans are available from health insurance companies and are most commonly obtained through employers. Some of the top private insurance companies in the U.S. include:
- UnitedHealth Group
- Humana
- Anthem
- Cigna
- Blue Cross/Blue Shield
- Wellpoint
In contrast, public insurance is provided by the government to eligible individuals and families. Medicaid is a state-run government insurance plan offered at little to no cost to low-income people. Who qualifies and the coverage available varies from state to state. Medicare is available to all Americans over the age of 65 and people with certain disabilities. Medicare only covers a portion of medical expenses, and individuals often need supplemental coverage to go along with it.
The Affordable Care Act (ACA), passed by Congress and signed into law by President Barack Obama in 2010, has materially altered the provision of health insurance in the U.S. over the last decade. The ACA sought to reform the medical care system, to extend health insurance to all uninsured Americans, and to lower health care costs.
The following terms are commonly used to describe different parts of health insurance policies:
- Co-insurance: The percentage of health care costs that the insured must pay, even after they meet the deductible. For example, after meeting the deductible, the insured may be responsible for 20 percent of costs and the insurance company covers the other 80 percent.
- Provider: The physician, health care professional or facility that provides medical services to the insured. A primary care physician is the doctor that oversees the patient’s overall care and manages a wide range of services.
- Network: The providers and facilities contracted to provide health care services for patients who have coverage with certain insurance plans.
- Preauthorization: Prior approval from a health insurance company required before a patient can access certain health care services, medications or equipment.
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Health insurance example
The five main types of private health insurance plans available in the U.S. are:
- High-deductible health plan (HDHP)
- Point-of-service plans (POS)
- Exclusive provider organization plans (EPO)
These plans offer varying amounts of flexibility to consumers. Some allow patients to visit any doctor they choose, while others only allow patients to visit doctors within a small network. The amount that the insured has to pay for premiums also varies.
Insurance is a contract where you pay a little money at a time so you can be compensated later, especially in the case of a disaster.
Many people consider insurance to be making a kind of bet that bad things will happen: that's a good bet to make, because nobody is lucky forever. Legally, you need car insurance to drive. Without medical insurance, a serious illness could leave you broke. Life insurance is important so your family gets support when you die. House or apartment insurance will help if you have a fire. Insurance agents sell insurance policies, and they always have lots of customers.
What is Health Insurance?
Health insurance is an insurance product which covers medical and surgical expenses of an insured individual. It reimburses the expenses incurred due to illness or injury or pays the care provider of the insured individual directly.
Types of Health Insurance
Every individual is different and has a unique set of needs. A single health insurance product is not enough to cover every person’s individual requirements. This is precisely where there are a number of different types of health insurance plans available. Let’s take a look at what they are:
1. Individual Health Insurance
You can purchase an individual health insurance policy to provide cover for yourself, your spouse, your children and your parents. These policies typically cover all kinds of medical expenses, including hospitalisation, daycare procedures, hospital room rent and more. Under an individual health insurance plan, each member has their own sum insured amount. So, let’s say you’ve taken an individual plan for yourself, your spouse and both your parents with a sum insured of INR 8 lakhs. Each of you will be able to claim a maximum amount of 8 lakhs per policy year against your health insurance.
2. Family Floater Health Insurance
A family floater plan allows you to cover your family members under a single policy and everybody shares the sum insured amount. These plans are typically more affordable than individual plans since the sum insured is shared. Let’s say you purchase a family floater plan for you and your spouse with a sum insured of INR 8 lakhs. In a single policy year, you can make claims worth only INR 8 lakhs. Your spouse may make claims worth INR 6 lakhs and you could make claims worth INR 2 lakhs or vice-versa. Typically, family floater plans are ideal for young nuclear families.
3. Senior Citizens Health Insurance
These health plans have been designed specifically keeping the medical needs and requirements of senior citizens in mind. Most senior citizens policies offer additional cover, such as domiciliary hospitalisation and even some psychiatric benefits. Since older citizens are more likely to have health issues, these policies may require a full medical check-up beforehand and could be more expensive than regular insurance policies.
4. Critical Illness Insurance
There are a number of lifestyle-related diseases that are on the rise. Health issues such as cancer, stroke, kidney failure and cardiac diseases can be very expensive to deal with and manage long-term. This is precisely why critical illness insurance policies have been created. They can either be purchased as a rider or add-on with your regular health insurance plan or separately as their own plan. These policies offer cover for very specific issues and often provide claim payouts as a single lump sum payment after the diagnosis of a critical illness.
5. Group Health Insurance
Unlike individual and family floater policies, group health insurance plans can be purchased by a group manager for a large number of individuals. For example, an employer can purchase group insurance for all their employees or a building secretary may purchase such a plan for all the residents of the building. These plans are fairly affordable, but they often only provide cover for basic health issues. Employers often purchase these plans as an additional benefit for employees.
Benefits of Health Insurance
Purchasing health insurance is crucial for a number of reasons. Let’s take a look at the most important benefits of our health insurance policies:
1. Helps Deal with Rising Medical Costs
People purchase health insurance policies to safeguard their finances against ever-rising medical costs. An accident or medical emergency could end up costing you more than a few thousand rupees. With a medical insurance plan, you enjoy cover for everything from ambulance charges to daycare procedures, making it easier for you to get the care you need to recover.
2. Critical Illness Cover
Many health insurance policies will also offer cover for critical illnesses at an additional cost. Given the rising incidence of lifestyle-related diseases today, this is another crucial cover to have. You will be provided with a lump sum payout in case you are diagnosed with any of the covered critical illnesses. These issues are often very expensive to deal with and manage, so critical illness cover is another vital benefit of having health insurance.
3. Easy Cashless Claims
Every health insurance provider will tie-up with a number of network hospitals where you can enjoy cashless claims. This makes the entire process of receiving emergency medical care much easier. At a network hospital, you aren’t really required to pay for any of the covered treatments. For all valid claims, we’ll take care of the medical costs, without you having to pay for anything, except non-covered expenses and the mandatory deductibles.
4. Added Protection
If you enjoy cover under a group health insurance plan, you may wonder why you should purchase your own health insurance policy. Well, individual health insurance plans offer provider more and better cover than group plans. Additionally, if you happen to leave the group at any time, you risk losing the cover, which could make you and your finances vulnerable.
5. Tax Savings
Under Section 80D of the Income Tax Act, 1961, premiums paid towards the upkeep of health insurance policies are eligible for tax deductions. For a policy for yourself, your spouse, your children and parents below the age of 60, you can claim a deduction of up to INR 25,000 per year from your taxable income. If you’ve also purchased a policy for a parent who is over the age of 60, you can claim an additional deduction of INR 50,000.
