What does Health Insurance Cover?

Health Insurance is a written agreement between you and your insurance company that includes their terms and conditions. The insurance policy consists of a list that includes several health benefits like tests, drugs, and the treatment services that are needed at the time of need. 

You receive certain services that are called covered services, and in this, you get a few cost benefits about the covers listed in the policy.

So, how does someone get to know what that particular policy includes?

If you already have an insurance plan or even if you wish to renew it then also you would like to know about the services that are covered in it. Every plan is different as it covers different sets of services that are covered within it.

What are the Essential Health Benefits Provided in Insurance?

Mostly, preventive services are one thing that is provided in the insurance plans, but it doesn’t mean anywhere that these services are for free. Usually, you still have to pay for deductibles, copayments, or other out-of-pocket costs.

At Least ten essential health benefits that come under the Affordable Care Act (ACA) are included within it. These ten are as follows-

  1. Ambulatory patient services- These are the services where the care of the outpatient is given without being admitted to a hospital.
  2. Emergency services.
  3. Hospitalization- hospitalization includes services such as surgery.
  4. Pregnancy, maternity, and newborn care- In these services you take care before and after your baby is born.
  5. Mental health services and Substance use Disorder services- These mental health services include behavioral health treatment in which counseling and psychotherapy are included.
  6. Prescription drugs- The drugs that are prescribed by the doctors.
  7. Rehabilitative and Facilitative Services and devices- In the services and devices, people who suffer from injuries, disabilities, or chronic conditions, gain or recover mental and physical skills are helped.
  8. Laboratory services.
  9. Preventive and wellness services. 
  10. Chronic disease management.
  11. Pediatric services- The pediatric services include oral and vision care, but adult dental and vision coverage aren’t EHBs.

What are the Preventive Services?

In Preventive Services, the diseases are detected and help you to prevent illness and other health problems. Such services are provided based on your gender, age, medical history, and family history.

  1. Abdominal aortic aneurysm- It is a one-time screening for men between the age group of 66-75 who have smoked.
  2. Alcohol Misuse screening and counseling to check your alcohol level and guide you.
  3. Aspirin use, in this test adults between 50-59 years are tested who would benefit from its use.
  4. Blood pressure testing.
  5. Cholesterol screening for those adults who are at high risk.
  6. Colorectal cancer screening for those adults between 50-75 years.
  7. Depression screening.
  8. Diabetes (Type 2) screening for adults of age 40-70 years and are overweight as well.
  9. Diet counseling for adults having a high risk of chronic disease.
  10. Fall prevention for adults of 65 years and over.
  11. Hepatitis B screening for people being at an increased risk.
  12. Hepatitis C screening for people with higher risk.
  13. HIV screening. 
  14. Immunisation vaccines.
  15. Lung cancer screening for those who suffer from cancer due to smoking and are between the age group of 55-80 years.
  16. Obesity screening and counseling.
  17. Sexually transmitted infection, prevention, and counseling for those at high risks.
  18. Statin preventive medication for adults of 40-75 years and at increased risk.
  19. Syphilis screening for those at increased risk.
  20. Tobacco use screening.
  21. Tuberculosis screening for adults at increased risk.

What should one do?

One should take time to read the insurance policy and then read it thoroughly. You should know what the company will provide you and for what services you are paying, and do get tested before filling a prescription. Before, the doctor provides you some extra care to tell the insurance company well in time. If you want to know about the policies and services in detail then ask the representative of the company to explain them in detail. Remember that, it’s the Insurance Company that will tell you about what will be paid to you and whatnot.

What to Consider while Buying Insurance?

Before you take the insurance the company may ask you to pay for some basic services that are covered in the plan. This includes the following-

  1. Copayment– Copayment is also called ‘COPAY’. It includes the payment of visits, tests, services, and the medication provided. Specialists have to pay more than family doctors.
  2. Deductible- It is the term used for the amount that one needs to pay every year before the company covers the entire money. Mostly, it is referred to as, “meeting your deductible”.
  3. Coinsurance– Some insurance companies also require coinsurance even after you have paid the deductible for the first year. It is the percentage cost you still need to pay for some years.

You need not know about everything in detail, but before signing read about the coverage plans it covers.

Read More: 6 Best HR Software You Should Consider

Post Author: bookbb

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