Like any other forms of insurance,
The person insured may also take several obligations in the form of the following:
Premium-this is the amount that the person, who is called the policy holder, or his company, which can be referred to as the sponsor, has to pay to the plan on a monthly basis.
Deductible-this is the amount that the person insured must pay out of his pocket before the insurer of
Co-payment-this is the amount the policy holder should pay out of his pocket again before the insurer starts paying for a certain visit or any service. An illustration of this will be- the policy holder should pay $50 co-payment for a visit the doctor or in obtaining a prescription. Therefore, a co-payment must be done each particular time that a certain service will be obtained.
Co-insurance-aside from paying a certain fixed amount in advance or up front, like a co-payment, the co-insurance, on the other hand, is a percentage of the certain total cost that the policy holder or the person insured should also pay. This happens when a person has to pay 30%, for instance, of the total cost of the surgery he has undergone which is over and above the certain co-payment, while on the other hand, the insurance company will be paying the remaining 70%. Depending on the actual costs of the particular service obtained, the insured person has the tendency to owe a very little, or a definitely great deal instead, if there is an upper limitation on co-insurance.
Exclusions-the policy holder has to keep in mind that not all services are definitely covered by the insurance company. The person insured is definitely expected to shoulder the full cost of any non-covered services.
Coverage limits -there are
Out-of-pocket maximums-this is quite similar to coverage limits, but in this case, the policy holder’s obligation of payment ends when they reach the certain out-of-pocket maximum, and then the insurance company will pay all remaining covered costs. This can also be limited to a particular benefit category, like drug prescriptions, or it can also be applied to all coverage period for a certain benefit year.
Prior Authorization-this is a certification or as the term implies, authorization, that a
Explanation of Benefits-this is a document that must be sent by the insurance company to a patient with the detailed explanation on what was covered in a certain medical service, and on how the company arrived at the certain payment amount and whatever the patient’s responsibility or obligation to pay.
If at this point, you are on the verge of getting one, make your comparisons. Ask for different
Source by Hal Johnson