Health Insurance Coverage

Health insurance coverage varies greatly, but basically it is a type of insurance policy that pays a pre-negotiated percentage of a policy holder's covered medical treatments.

Do you really need health insurance or can you live without it? The answer depends on whom you ask and the question is not always an easy one.

Like other forms of insurance, health insurance doesn't really become an issue until you need it. Automobile insurance doesn't do you any good until you get into a car accident. Life insurance doesn't do you any good until you die. And health insurance doesn't do you any good until you need medical assistance. If you believe in Murphy's Law, that whatever can go wrong, will go wrong, then you probably should consider getting health insurance.

In some countries, health insurance is not offered by private companies like it is in the United States. In England, France, Canada, Sweden and Norway, for example, the doctors and hospitals are reimbursed by the government instead of an insurance company.

In the United States, there are three basic types of health insurance:

1) Self-Insured/Uninsured. This is where an individual has no insurance or has health insurance but is responsible for paying 100% of the insurance premium. This group is estimated to comprise at least 30% of the US population.

2) Managed Care Plans. Managed Care Plans fall into three categories. All are essentially networks to provide contracted services by specific providers at contracted prices:

i) Health Maintenance Organizations (HMO) are prepaid plans in which members pay a fixed monthly fee, regardless of how much medical care is needed in a given month. HMOs provide medical services ranging from office visits to hospitalization and surgery, and usually insist that you stay within the network when you need services from physicians and hospitals.

ii) Preferred Provider Organizations (PPO) are groups of doctors and hospitals that provide medical service only to specific groups. PPO members typically pay for services as they are provided, and the PPO sponsor typically reimburses the member for the cost of the treatment. In most cases, the price for each type of service is negotiated in advance by the healthcare providers and the PPO sponsor.

iii) Point of Service (POS) plans are not as common as the other two. This is a type of managed healthcare system in which you pay no deductible and usually only a minimal co-payment when you use a healthcare provider within your network. You also must choose a primary care physician who is responsible for all referrals within the POS network. If you choose to go outside of the network for healthcare, you will be subject to excess charges or deductibles.

3) Indemnity Plans enable participants to seek medical assistance whenever they need. Participants can visit any doctor or specialist, as often as they feel necessary. There are no restrictions when it comes to seeking medical help, but this is by far the most expensive type of health insurance plan.

Which of these types of health insurance is right for you will depend on your personal situation. Choosing health insurance coverage is a time-consuming task and it can certainly be frustrating, but it's something that everybody needs to consider sooner rather than later.

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