Health Insurance

hello everyone welcome to my channel before watching this article don't forget to like comment and subscribe now let's start this article health insurance health insurance or medical insurance are also known as Medical Aid in South Africa is a type of insurance that covers the whole or a part of the risk of person in curing medical expenses as with other types of insurance rates is shared among many individuals by estimating the overall risk of health risk and health system expenses offer the risk pool an insurer can develop a routine Finance structure such as a monthly premium or payroll tax to provide the money to pay for the health care benefits specific sorry specify in the insurance agreement the benefit is administered by a central organization such as a government agency private business or not poor sorry or not for profit anxiety according to the how Insurance Association of America'

health insurance is defined as coverage that provides for the payments of benefits as a result of sickness or injury it includes Instagram for losers from accident medical expense disability or accidental death and dismemberment a health insurance policy is first a contract between an insurance provider in example an insurance company or a government and an individual or his or her sponsor that is an important that is an employer or a community sorry that is an employer or a community organization the contract can be renewable or annually or monthly or lifelong in the case of private insurance it can also be mandatory for all citizens in the case of national plans the type and amount of health care costs that will be covered by the health insurance providers are specified in writing in a member contract or evidence of coverage booklet for private insurance or in a national or health policy for public insurance second United States specific in the United States there are two types of health insurance taxpayer founded and private founded an example of a private founded insurance plan is an employer sponsor self-founded or a Visa plan the company generally advertises that they have one of the big insurance companies however in an Arisa case the insurance company does not engage in the act of insurance they just administer it therefore Arisa plants are not subject to state laws every supplants are governed by federal law under the jurisdiction of the United States Department of Labor of r usdol the specific benefits or recover its detail are found in the summary plan description or SPD an appeal must go through the insurance company then to the employer's plan five sorry to the employer's plan fiduciary require the fighter carries decision can be brought to the usdol to review for Arisa compliance and then file a lawsuit in federal court the individual insurance person obligation may take several forms first premium the amount the policyholder or their sponsor in example an employer pays to the health plan to purchase health coverage or United States Pacific according to the Health Care law a premium is calculated using five specific factors regarding the interior person these vectors are age location tobacco use individual versus family enrollment and which plan category the insurer chooses under the Affordable Care Act the government pays tax credit to cover part of the premium for person who purchase private insurance through the insurance 

Marketplace second deductive sorry second deductible the amount that the insurer must pay out of pocket before the health insurer pays its share for example policyholders make have to pay a 700 7 500 US dollar deductible per year before any of their health care is covered by the health insurer it may take several doctors visits or prescription refills before the insurance person reach detective table and the insurance company start to pay for care furthermore most policies do not apply co-pays for doctor's visit or prescription against your deductible third co-payment the amount that the insured person must pay out of pocket before the health insurer pays for a particular visit or service for example an interior person may pay a 45 US dollar co-payment for a doctor's visit or to obtain a prescription a co-payment must be paid each time a particular service is obtained four coinsurance instead of or in addition to paying a fixed amount upfront or a co-payment the co-insurance is a percentage of the total cost that an injured person may also pay for example the member might have to pay 20 of the cost of a surgery offer and above a co-payment while the insurance company pays the other 18 percent if there is sorry if there is an upper limit on coinsurance the policy holder could end up owing very little or a great deal depending on the actual cost of the surface they obtain fifth exclusions not all service are covered build items like use and throw taxes Etc are exclude from admissible claim the insurer are generally expected to pay the full cost of non-covered surface out of their own pockets 6. coverage limit some health insurance policy only pay for Health Care up to a certain dollar amount the insurance person may be expected to pay any charge in excess of the Health Plan's maximum payment for a specific service in addition some insurance company seems have sorry in addition some insurance companies claims have annual or lifetime coverage maximum in this case the health plan will stop payment when they reach the benefit maximum and the policy holder must pay all remaining costs seven out of forget maximum similar to coverage limit accepted in this case the insurance person payment obligation ends sorry except that in this case the insurance person payment obligation ends when they reach out the when they reach the out of pocket maximum and help Insurance base of other cover course out of pocket maximum can be limited to a specific benefit category or such as prescription drugs or can apply to all coverage provided during a specific benefit year age capitation an amount paid by an insurer to a healthcare provider for which the provider agrees to threat all members of the insurers 9. in-network provider United States term a healthcare provider on a list of providers preselected by the insurer the insurer will offer discount a co-insurance or co-payments or additional benefits to a plan member to see an in-network provider generally providers in network are profilers who have a contract with the insurer to accept rates further discount from the usual and customary charges the insurer pays two out of network providers 10 out of network provider a healthcare provider that has not contracted with the plan if using an out of network provider the passion may have to pay full cost of the benefits and service received from the provider even for emergency service out of network providers May build patients for some additional costs associated okay everyone that's all this article today thank you so much for watching this article until the next one bye

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