Health Insurance Policy-Important Information You Need to Know
Having a good health insurance policy is important, even if you aren’t financially strapped. Unless you are self-employed, you may receive the option to purchase health insurance as part of your employee benefits package at work, usually at a discounted rate, since in most cases, the employer picks up a portion of the cost. Even if you are in great physical health, you never know when a medical emergency may arise, requiring emergency medical treatment, which can be quite expensive, especially for those who don’t have insurance coverage. It can be confusing when trying to fully understand your health insurance plan, as there are often unfamiliar terms and limitations. In this article, we will talk about some of the basic terminology that you may see in your health insurance paperwork, so that you will be able to fully understand your policy.
The first thing that you need to know about is your deductible. The deductible is the amount you have to pay up-front, out of pocket, before your insurance coverage kicks in. You will be required to pay this amount each year, before any payments will be made by the insurance company on your behalf.
Most insurance policies also require you to pay a co-payment each time services are rendered, the amount varying depending upon the terms of your plan. In some cases, you may be required to pay $20 each time you see your MD, and if you see a specialist, this amount may increase. Once you have paid your co-pay, the insurance will then pick up the remaining cost of your visit.
Not all medical treatments are covered by every health insurance plan; there will be some services that you will have to pay for entirely on your own. There is usually a maximum amount for out of pocket payments, and then after that point, the insurance will start to pay.
Most health insurance plans also have maximum lifetime coverage amounts, meaning that if you meet that coverage limit, then your policy will then be ineffective and cancelled. This is usually a hefty amount, and in most cases, reaching the maximum is not an issue for the average person.
You need to pay special attention to the exclusion portion of your policy, as this is where you will find out what services the policy will not pay for. This usually involves certain surgical procedures, especially any that aren’t proven to be medically necessary.
If you have had any past health problems, especially within the past year that you have sough medical treatment for, or are taking prescription medication for, you will probably fall into a pre-existing condition clause. This means that for a certain period of time after your policy goes into effect, treatment for that condition will not be covered by your health insurance plan. You will have to pay for treatment out of pocket, until you have reached the end of your pre-existing condition time frame, usually about a six month period.
There are lots of things to think about when studying your health insurance policy, and becoming familiar with the terminology used can help you best determine what your policy does and does not cover. Knowing this up front, before you need any medical treatment, can prevent you from getting unexpected bills in the mail for what the policy doesn’t cover.