The Way Health Care Insurance Works
The Way Health Care Insurance Works
In public health care insurance, people who are registered as citizen, permanent resident or temporary residents who lives more than one year have rights to receive healthcare coverage where the fund are organized by federal, or provincial government. Some countries provide this coverage free of charges and no salary payment cutting, but several countries also cut small percent of salary and levy adjustments as the insured payment.
What should we know about health care protection?
Premium
Premium is certain amount of money that the insured or sponsor (for employee insurance) must pay for the health care coverage. The premium might vary depend on the coverage.
Coverage limits
The insurer has set the payment limit for coverage. This limit is a maximum fund usage for the insured for certain medical treatment and hospital services. The insurance company will stop paying after the insured reach maximum limit of medication coverage, and the insured should pay the rest of the expenses by themselves.
Exclusions
It is a special case treatment which can't be covered by the insurance companies. There are different standards for this exclusion depends on the premium payment and the insurance company. In general, aesthetic medication is applied as exclusion in most insurance policies.
Capitation
Is amount of money that insurance company should pay to medical or health care providers that provides the services noted in the policies agreements.
Deductible
It is a liability that insured must pay before the insurer pays the share. Deductible usually paid annually, or depends on the agreement. In some countries, the deductible lasts for 3 months. After that, the insured can use this insurance as their health care coverage, while in others deductible might last for a year.
Co-Payment
It is the money that a person should pay for a doctor visit or buying prescription before the insurance works for the coverage.
Co-Insurance
It is the fixed amount percentage that a person should pay for particular medical action. For example, you should pay 15% of hospitalization expense while insurance paid 85% of it.
Explanation benefits are an explanation of benefits and coverage that you can have and you find in the contact.
These are the basic terms that you will find in Health insurance, it is better to recognize and read these terms carefully.
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