Understanding Health Insurance Plan Benefits

Donald Saunders

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It is all too easy to assume that if you have a health insurance plan then you are covered for eventualities. Unfortunately this is not the case and not only will the majority of healthcare plans exclude certain forms of treatment, there is also considerable variation between individual policies. In addition, it is also thought that once you have paid your premium then your medical bills are covered. Again this is far from the case and you will be expected, regardless of the policy you choose, to meet at least a proportion of your medical costs.

Ideally a personal or family healthcare plan would cover you from everything from preventative care through to major accidents and hospital care and everything in between. In reality however the treatment to which you are entitled under your policy will almost certainly be limited and the policy will rarely meet one hundred percent of your costs. For this reason, it is vitally important that you read through the small print of any policy before signing up for cover and that you fully understand just exactly what you are and are not getting.

Traditionally indemnity, or fee-for-service, policies have not covered you for preventative treatment, such as annual check-ups and immunization, although this is normally covered under HMO plans. Today, however, the situation is changing and more and more insurance companies are coming around to the view that they can save a great deal of money if they concentrate more of their efforts on encouraging policyholders to stay healthy in the first place. For this reason it is increasingly common to see preventative medicine covered by policies and some will even offer discounts on the use of health club facilities and programs that help policyholders to quit smoking.

The sort of things that most policies will cover today include annual check-ups, immunization, annual eye checks, routine medical care, pre-natal care, well baby visits, urgent and emergency care and hospital care, including x-rays, blood tests and other laboratory work.

It is important however to remember that the exact mix of treatment that is covered will vary from one policy to the next and so you must check any policy document carefully to see exactly what is insured. Just as importantly, you must also read through the policy to what is specifically excluded.

Most health insurance plans will clearly list medical treatment that is excluded and this will typically include dental and vision care (other than an annual routine eye check) and a lengthy alphabetical list covering everything from acupuncture to weight loss treatments.

You may find that on a few policies dental and vision care is covered but, in general, health insurance policies in the United States do not cover these areas and separate dental cover and vision cover policies would need to be arranged.

Another area to pay particular attention to is that of cover for the cost of prescription drugs. As the cost of prescription drugs continues to rise alarmingly an increasing number of insurance companies are excluding the cost of drugs from their policies. It is also becoming increasingly common for cover for the cost of prescription medication to be made available through separate policies, as in the case of cover for dental and vision care.

One final point to remember is that several states lay down specific requirements for healthcare insurance sold to state residents. These requirements are designed to provide residents with protection against unscrupulous practices by the insurance companies and are generally of considerable benefit to policyholders. Such benefits are however not transferable and benefits may be lost, or gained, as you move between states.

Health insurance can be a complex area and all too many people assume that they are covered until they have an accident or fall ill and suddenly discover either that they are not covered at all or that they will have to meet a substantial proportion of the bill. The secret is simply to read through any policy document before you take out cover and make sure that you are getting the cover that you need and want.

For more information on finding a low cost health insurance policy or perhaps are in a position to take advantage of the many state benefits such as those provided by California individual health insurance then there is no better place to start your search than right here online.


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