What are the basics of health insurance policies?

Submitted by frndzzz on Sat, 04/03/2021 - 23:16


Basics of health insurance

Healthcare expenses continue to go up and many people simply don’t have the funds to compensate for their healthcare expenses. Those individuals who begin with sizable savings account without health insurance shortly see that their savings have been used up and medical bills are escalating.

Medical bills are one of the main causes of debt for American households. When you don’t have a health insurance policy to cover the healthcare expenses of both you and your family, your financial life can be destroyed at any time.

The basics of health insurance policies are:

Given below are some basic health insurance terminologies that you should know when you’re thinking about buying health coverage:


A premium is an amount that you or the policyholder needs to pay every month for health insurance. It is like the homeowners’ and car insurance premium that you pay.


The deductible is the amount that you need to pay as out of pocket expense before any expenses are covered by your health insurer. When you have a deductible of $1,000, you would need to pay $1,000 for expenses on your own before your insurance company pays for anything. Cheap health coverage plans frequently ask for higher deductibles.


Health insurance carriers frequently necessitate you to make a copayment when they provide their services. The copayment is a fixed dollar value that is added to the amount that the health insurer would pay for the service like an office visit, filling of a prescription, or outpatient service. If your copayment for a doctor’s visit is $25 and the cost of the visit is $100, then you need to pay $25 and the health insurer pays the rest $75.


Your insurer pays a particular portion of your medical bills and you pay the other part. It is also named percentage participation. Coinsurance rates are frequently mentioned as a ratio like 90/10 or 80/20. If your coinsurance rate is 90/10, your insurer would pay for 90% of the medical bills and you would pay 10% of that. Many companies offer a coinsurance cap that would restrict your out-of-pocket expenses.

Coverage limit

A coverage limit is the highest amount that the insurer would pay throughout a period of time. This limit might only be applied every year or it can be applicable to the entire term of the policy. You’d have to entirely cover any expenses that surpass the coverage limit.

Out of pocket maximums

It determines the highest amount of money you’d pay as out-of-pocket expenses for healthcare during a specific time frame. As soon as you arrive at your out-of-pocket maximum, the insurer would comprehensively cover the remainder of expenses.


Exclusions are services or facilities that are not compensated by the insurer. You’d have to entirely cover any medical expenses that your policy doesn’t cover. Examples are eye and dental coverage, pre-existing conditions, and cosmetic surgery.

Types of health insurance coverages

Given below are the main types of health coverages:

1) Indemnity or fee for service plans

2) Managed care plans: Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Point of Service (POS) and EPO (Exclusive Provider Organization).