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Health
Insurance
 Health
Insurance Defined
Health
insurance
is defined as an annually renewable insurance contract
between a health insurance company and an individual or
legal entity. It insures
against loss by illness or bodily injury. Health insurance
provides coverage for medicine, visits to the doctor or
emergency room, hospital stays and other medical expenses.
Generally, health insurance policies will differ in what
they cover.
The
insured usually shares in the cost of the claim by paying a
deductible and a
co-payment. Most policies that are
comprehensive have a maximum out-of-pocket payment for any
single year, and some also include a lifetime maximum.
Health insurance
was first conceived in the late 1600s. This coverage
was intended for disabilities rather than what we now know
as comprehensive health insurance.
It was only
in the last 60 years that the health insurance concept
evolved into modern health insurance programs. Today,
comprehensive private health insurance plans may cover the
cost of routine care, preventive care, emergency
health care and more. This may include ancillary coverage
for prescription drugs and dental.
Modern health care
providers, doctors, hospitals, etc., will
usually bill the insurance company for insured
services when an agreement is signed by the
insured that will deem the insured responsible
for the amount that the insurance company does
not pay and /or is not covered.
Health insurance
companies also often have a network of providers
who agree to accept the reasonable and customary
fee and waive the remainder. It will generally
cost the patient less to use an in-network
provider.
The principle of managed care
is to manage and integrate
health services. The managed care organizations provide
these health care services to members through doctors,
hospitals and other health care providers through contract
agreements. For these reasons, it is important that one
understand covered benefits before medical services are
rendered.
Health Insurance Plans in the
United States are available through the following resources:
Private Health Insurance
Private health
insurance is coverage by a health plan provided through an
employer or union or purchased by an individual from a private
health insurance company.
Employment-based plans
Employment-based health insurance is coverage offered through
one’s own employment or a relative’s. It may be offered by an
employer or by a union.
Direct-purchase plans
Direct-purchase health insurance is coverage though a plan
purchased by an individual from a private company.
Government
Health Insurance
Government
health insurance includes plans funded by governments as the
federal, state, or local level. The major categories of
government health insurance are medicare, medicaid, the State
Children’s Health Insurance Program (SCHIP), military health
care, state plans, and the Indian Health Service.
Medicare
Medicare is the Federal program
which helps pay health care costs for people 65 and older and
for certain people under 65 with long-term disabilities.
Medicaid
Medicaid is a
program administered at the state level, which provides medical
assistance to the needy. Families with dependent children, the
aged, blind, and disabled who are in financial need are eligible
for Medicaid. It may be known by different names in different
states.
SCHIP
SCHIP, the
State Children’s Health Insurance Program, is a program
administered at the state level, providing health care to
low-income children whose parents do not qualify for Medicaid.
SCHIP may be known by different names in different states
Military health care
Military
health care includes TRICARE/CHAMPUS (Civilian Health and
Medical Program of the Uniformed Services) and CHAMPVA (Civilian
Health and Medical Program of the Department of Veterans
Affairs), as well as care provided by the Department of Veterans
Affairs (VA).
TRICARE/CHAMPUS
TRICARE or
CHAMPUS is a military health care program for active duty and
retired members of the uniformed services, their families, and
survivors.
CHAMPVA
CHAMPVA is a
medical program through which the Department of Veterans Affairs
helps pay the cost of medical services for eligible veterans,
veteran‘s dependents, and survivors of veterans.
VA
The Department
of Veterans Affairs provides medical assistance to eligible
veterans of the Armed Forces.
State Specific Plans
Some states
have their own health insurance programs for low-income
uninsured individuals. These health plans may be known by
different names in different states.
Indian Health Service
Indian Health
Service (IHS) is a health care program through which the
Department of Health and Human Services provides medical
assistance to eligible American Indians at IHS facilities. In
addition, the IHS helps pay the cost of selected health care
services provided at non-IHS facilities.
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coverage online.
It is mandated by each state
insurance commission product
filing that the rate not be changed by any sales entity;
therefore, rates will be the same from all websites. This assures the buyer of always receiving the best
rate on any
and all insurance products.
HealthInsuranceQuotesAmerica is a licensed health insurance agency (License #'s:
for
HealthInsuranceQuotesAmerica are issued to
Lewis Fink, CA: OC38446 MT:
29724 F00-0283-LC), and a major resource for individual and family coverage.
HealthInsuranceQuotesAmerica is independent of any company or company
products offered. Depending on the plan and the state of residence, plans may vary.
The quotes generated by this program are not a contract, binder, or agreement to extend coverage and are based on the listed factors and
the applicable underwriting criteria for the rate shown. The exact
premium can only be determined after an underwriting review and may
be different or the policy may not be available. Your information is only shared with the company underwriter and never distributed in
any
other way.
All health insurance
definitions defined here are to be understood as being general definitions.
These definition may vary by insurance company and may be found in the
company policy or certificate of insurance. Not all products from all companies are available in all
states.
Advise Notice: We do not provide legal advice on this site. The general information presented on various legal aspects of plans herein
are not intended to be relied upon as legal advice. Individuals should always seek
the advice of a qualified legal professional.
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P.O. Box 30248 Charleston, SC 29417
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