Health Insurance FAQ

What Is A Deductible?

A deductible is the amount of money you must pay during any given time out-of-pocket before the insurance company will pay. So, if you have a $500 annual deductible, then that means that the first $500 in medical expenses you incur each year, you must pay yourself. After that point, the insurance company will pay a large portion of your costs.

The exact percentages and amounts the insurance company will pay after you’ve exhausted your deductible vary from policy to policy, so make sure you understand clearly what you will have to pay after this, and if there are any exceptions that the insurance company will pay for before you’ve met your deductible.

Can You Explain A Mandate Benefit?

This is a type of coverage that a health insurance provider is legally required to offer based on state laws. This varies from state to state, but common examples include nervous disorders, hospice care, and treating drug abuse.

What Hospital Outpatient Expenses Are Covered?

Generally emergency treatment, surgery, and services provided to you in the x-ray department or outpatient laboratory are all covered. These include CT scans, physical therapy, MRI scans, ambulance service, and consultations.

Are There Advantages To Group Insurance Rates?

Yes. Individuals seeking health insurance without coverage from a group purchaser, such as their employer, a trade union, or a credit union, are required to share a lot of personal information with the health insurance provider. Information includes income, medical history, personal habits, and other information that helps the company assess the risk of taking on that individual.

By contrast, when health insurance companies sell group packages to one of the entities mentioned above, they don’t usually need to run such background checks because the larger the group they are insuring, the more likely it is that the premiums paid by everyone in the group will cover the cost of the few who become sick over a given time period.

This means that health insurance companies can offer more generous plans for individuals insured through a group, as well as offer lower rates for the same level of coverage.

Can You Explain A Base Plus Plan?

Base plus plans divide your coverage into two parts: basic medical coverage and major medical coverage. Each of these types of coverage has different regulations.

Basic medical coverage, which covers hospitalization, doctor visits, x-rays, and other more routine procedures, is completely covered by your health insurance provider up to a certain limit. Limits include number of days you can be hospitalized or visit a doctor in a given day, etc.

Major medical coverage is for basically anything not covered under the basic medical coverage, and you have free reign to choose which services work for you in order to meet your medical needs. The difference is that you have a deductible on your major medical coverage which you must pay out of pocket, and you will also probably have to shell out your own cash for co-pays.