Health Insurance Comes Under which Group in Tally

Health Insurance Comes Under which Group in Tally

You should have health coverage in place for you and your family when you need it. It takes one debilitating injury, or a serious illness, and the bills can start to accumulate rather quickly. In the United States, 57 percent of families who have health insurance are typically covered by employer-sponsored group health insurance plans. Government health insurance plans, such as Medicaid and Medicare covers another 29 percent of Americans. The other 14 percent of the people are self-employed, work for a company that does not offer health insurance coverage or simply must feign for themselves and their families in the private market if they can afford it.

Health Insurance Comes Under which Head in Tally

The other option is to seek medical assistance at county-owned hospitals. Obtaining family coverage in the private market is much more challenging than qualifying for group coverage that is offered as part of an employment benefit package. Purchasing health insurance for your family is a very important event and should be done with careful consideration. Before you buy any type of family health insurance coverage there are some basic industry terms and provisions that you should understand:

Network

When comparing family health insurance plans, one aspect that you must consider are the hospitals and health care providers that make up the plans network. You should verify that the health care facility and physician of your choice are part of the network. If they are not members of the group, many plans will allow you to choose outside the network. However, this will raise your health insurance cost. If having your own doctor or hospital is important to you, make sure they are approved before making a commitment to purchase a plan.

Premium

This is the amount that you must pay each month for health insurance coverage. Typically, the premium is based on factors, such as deductibles, co- payment (co-pay) and prescriptions that are covered under the plan. For example, many plans offer you the option of paying a higher out-of-pocket cost, or deductible, in exchange for a lower monthly premium. Many people choose the higher deductible and save the coverage for larger claims.

Annual Deductible

Do not confuse the annual deductible with "co-payments." An annual deductible is the amount of money you must pay each year towards your health care services before the insurer starts to pay. The deductible may be as low as $250. Usually, deductibles for family plans are double the annual deduction for individual policies. For example, if the individual deductible is $1,000, the family plan requires a $2,000 amount. This figure must be reached before the health insurance company is obligated to pay toward a medical claim.

Some policies contain an "embedded deductible" provision. This means that a minimum of two family members must each satisfy the deductible amount for the calendar year, in order for claims generated by the entire family to be covered. So, if one family member reaches the $1,500 deductible requirement, subsequent claims that are generated in the calendar year for that individual will be paid by the health insurance company, according to the terms of the policy.

A different member of the family would also have to satisfy the $1,500 deductible requirement before the entire family will be covered.

First Dollar Benefits

Although most family health insurance plans require you to meet the deductible before the company will pay, there are specific services that may be covered by the policy before meeting your annual deductible and /or co-insurance amounts. These health care services may include services, such as child wellness, vaccinations, preventative care, generic prescriptions or physical and gynecological examinations.

Co-payments

This is the cost you must pay when you or a family member visit the doctor. This amount may range from $25 to $40. Often, it is sold as an optional feature of health insurance policies. It is chosen by most people to avoid having to pay for the entire cost of their visits. In some plans that offer prescription drug benefits, you may be responsible for co-pay for each prescription. The amount you pay is usually based on whether the drug is a name brand or generic drug.

Co-insurance

Coinsurance is another term that you probably will encounter during your evaluation of family health insurance. This refers to the amount that health insurers require you to pay for any health care expenses, in addition to your deductible. Usually, it is calculated on the next $10,000 in medical costs over the deductible. Generally, the break down is an 80/20 ratio. This means that after the deductible has been satisfied, the insurance company would pay 80 percent of the bill. You would be responsible for the other 20 percent of costs up to $10,000.

Lifetime Maximum Coverage

Most health insurance policies place a limit on the maximum dollar amount that they will pay over your lifetime. Typically, this amount ranges from about three to eight million dollars. Some insurance company may offer a provision that allows you to purchase more lifetime coverage. If you reach the maximum lifetime coverage amount contained in your policy you are responsible for any expenses that exceed the designated figure.

Individual health insurance coverage is underwritten on an individual basis; so, your medical history and that of your family more closely. Cases of pre-existing conditions increase the probability that your application for coverage will be denied. Or at the very least, a rider may be added to the policy which exempts the "pre-existing condition" from coverage. You should get health care coverage before you have any medical issues.