Obligations of Health Insurance Holders

Most health insurance holders know that a health insurance is a written contract between an individual and their insurance company. This is a kind of contract that is renewable either monthly or annually. The amount and type of health care cost which is covered by the plan is stated and specified in advance so that the individual can identify if the plan fits his or her needs or if certain adjustments should still be made.

Just pay the agreed insurance plan and let the company do the rest. This is the usual idea that insurance holders deal with. Therefore, the main obligation of individuals is to pay their dues. These obligations come in several forms.

Premium

This is the amount indicated that the policy-holder must pay to the health agency every month in order to purchase the said health coverage.

Co-insurance

This happens when a policy-holder pay only a percentage instead of giving the entire fixed amount of the plan. A typical example would be - a member who has undergone surgery only pays 30% of the total cost and the health plan is the one responsible in paying the remaining 70%. Because there are no limits on the co-insurance, the patient ends up owing just a small amount which depends on the actual expenses of the obtained services.

Deductible

This is the amount that the policy-holder is responsible for. Before a health plan pays part of its share, the policy-holder must first bring out of his or her own pocket the contribution agreed upon. It may take numerous visits to the doctor, refills of prescription before one reaches the deductible.

Exclusions

As the word implies, there are some services which are not covered by the health plan. Here, the policy-holder is required to pay the expected amount out of their own pockets because the particular service is no longer covered by the insurance company.

Coverage limits

This pertains to the limit given by the insurance. There is just a given minimum amount that the insurance covers. If the charges reached the excess, the policy-holder is then required to pay the amount for specific services. Furthermore, there are plans that have lifetime or annual coverage maximums. With these cases at hand, the health plan stops the payment.

In-network provider

These are providers enlisted by the insurer. If a policy-holder sees an in-network provider, the insurer will give discounted co-insurance or additional benefits.