insurance

Coverage Characteristics of Health Insurance

Understanding the coverage characteristics of health insurance begins with a thorough analysis of your specific insurance needs. Health insurance comes in different forms. Each one will offer you some benefits and features not present in other policies. Therefore the health insurance coverage characteristics will also be varied. In the most general sense, the coverage of health insurance is the cost of checkups, medications and hospitalizations due to injuries or sickness that are part of the coverage. Let us look at the coverage characteristics of health insurance depending on what policy you are going to purchase.

With Fee for Service, the health provider bills the insurer for a certain fee and the said insurer is required to pay the whole cost or part of the cost. In the general sense, the insurance company has to follow specific guidelines in determining the amount that they are liable to pay. Thus, the coverage characteristics of health insurance are determined by this community standard. In this particular insurance option, the insured will have to pay a portion of the policy often called as deductible. Apart from that, the insured also needs to pay a fixed co-payment amount. That means if the co-payment is 20%, the breakdown is 20% your responsibility to pay while the rest is the insurance company’s cost, up to the amount you have insured for that contract.coverage characteristics of health insurance

In PPO, the coverage characteristics of health insurance are different. PPO means Preferred Provider Option. This is ideal if the insurance company has a certain doctor or hospital to be used by the insured for coverage. The coverage characteristics of health insurance will generally be similar though the price would be lower since you have chosen a health care provider within the network. Normally, the PPO will set a pre-negotiated fee and the insured has to pay a lower deductible and co-payment. If you go to a non-network insurance company, the fee you paid for deductibles and co-payments are much higher.

Finally, let us look at the coverage characteristics of health insurance for HMO. This one stands for Health Maintenance Organization. The health insurance coverage characteristics are quite varied since they come in numerous varieties. The first one is the Managed care with is a form of preventive care which involves in-house doctors. You can also opt for the fixed monthly fee in which there is a range of services that the patient can use. The coverage characteristics of health insurance are much more controlled since the expenditure is monitored much closely and there is permission to choose a health provider outside the network of the insurance company.

The health insurance coverage characteristics are varied depending on the kind of health service you need and other aspects necessary or relevant for your health. It is ideal that you analyze your needs and make the right assessments with a professional before you choose the right plan. Are you interested on the coverage characteristics of health insurance that fit your needs? Let us help you. Select your state and receive quotes from top insurance companies in your location.