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Insurance Article

Health Insurance- Important Definitions in insurance

March 06 2011

Usually memory fades with time as we become busy with our studies, career, business and personal issues and ignore the important factor of our lives despite of the fact that medical expenses are touching sky these days. Your health is the most important asset. Hence it’s indispensible for every individual to take a health insurance plan also to understand how it works. Let’s gain some basic knowledge about health insurance

Hospital: Healthcare facility that provides indoor treatments for illness, bad health conditions, accidents and other health related issues with the help of certified and qualified staff and equipments. Same could privately held, government aided, autonomous body. Types of hospitalization charges that can be covered under insurance: pre-hospitalization charges, post-hospitalization charges and patient hospitalization charges.

Pre-hospitalization charges are the charges incurred for treatment of disease/illness prior to a month of hospitalization (varies to 60 days). Patient hospitalization charges are those charges which occurred while patient is admitted as in-person and getting treatment for illness. Post hospitalization charges referred as the charges incurred post-hospitalization in order to recover from the surgery/operation or a disease for 60 days (varies for different providers).

Premium or deductible: Premium of deductible is a first amount that insured needs to pay for taking insurance policy. Same needs to be done before taking any medical assistance from insurer. It’s mostly a yearly payment and required to be paid again at the time of policy renewable for next year. Some of the insurers are providing few services without charge like doctor visits for health profiling, but same is in continuation for registering oneself for particular insurance plan. Insurer wants to notify the current health status before providing the services.

In case of doctors visitation and buying prescribed medication payments which has be done is known as a co-payment amount. It’s not the entire payment but the certain percentage and rest of the amount paid by the insurer. Out of pocket expense is to be paid from one pocket and not be reimbursed by the insurer. Lifetime maximum is a maximum amount one has to pay to get insured for lifetime.

In- network and out of network. In network stand for the chain of healthcare institutions those are covered under the particular health plan. Taking treatment form in-network institutions one need not to pay as its usually a cashless deal (as per the entitlement). One need to show the membership card and expenses will be bearded by the insurance provider. Out of network facilities are the other healthcare facilities those are not covered under the plan taken by the insurer. For taking services from such institutions, upfront payment is to be done and expenses are subjected to reimbursement after submission of reports and bills. It’s advisable to keep the details of in-network facilities handy for medical exigencies.


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