In basic terms health insurance for individuals is mitigating the risk of incurring medical expenses by paying a premium to an insurer. Premiums can be paid monthly, quarterly or annually. The insurer which is the health insurance provider will analyze the application of an individual and provide a cost of premiums based on the answers provided to them. Generally the insurer will consider factors such as age, existing health and past history before providing a quote and a policy.
A policy will act as a contract between the insurer and the individual and all details on the cover and the costs should be included in the policy document. Generally most policies will include the following information
The premium: This is the amount the policy holder i.e. you the individual, will pay the insurer. It should also include the how often the premium is to be paid. Generally they are paid monthly however they can also be paid on a quarterly or annual basis.
The Co-payment: This is the amount of monies that the policy holder will need to pay prior to the insurer paying for a particular service. This could be a payment relating to a prescription for example. The payment will need to be paid every time the service is used.
Exclusions: Here the policy document will detail all the products or services that are not covered by the policy. Typically any information that is detailed here will need to be covered by the policy holder should a need arise. This will need to be read in detail to make sure you have the cover required. If information is included here which you are not sure of, contact your insurer immediately for clarification.
Explanation of Benefits: This is where all the detail will be contained and where important information is on what is covered by the policy. So should also be studied to ensure you have the adequate protection you requested.
Coinsurance: Detailed in this section of the policy is the amount that will need to be paid in the event of a claim. Generally it will be a percentage of the overall cost of the claim. For example the policy holder may have to pay 10% of the costs while the insurer pays the other 90%.
It is important to note that all policies should be read thoroughly to ensure that you have adequate protection when taking out health insurance for individuals. This will also avoid any costly miss-understandings in the future should a claim need to be made on the policy. Unfortunately it is not uncommon to hear that people have not been paid out by their insurers due to some miss-communication or failure to read the small print in the policy and people who thought they were insured were actually not.
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