Health insurance

Health insurance is insurance against losses due to medical costs among individuals. By estimating the overall risk of healthcare costs between groups, insurance companies can access the financial structure of the routine, concentrating as monthly premiums or payroll taxes to ensure that the resources available to pay for health benefits stated in the insurance contract. These advantages are achieved by a central organization such as government agencies, private or not be run-for-profit organization reached.

History and Development (United States)

In the late 19th Century, "accident insurance" began to be available that looks like modern disability insurance. This payment model continued until the early 20th Century in some states (eg California), where all the laws that actually name the disability insurance.

Accident insurance was offered for the first time in the United States by the Franklin Health Insurance Company of Massachusetts. The company, founded in 1850, provides insurance protection against damage caused by accident, railroad and steamboat caused. Sixty organizations, accidents in the United States in 1866, but the industry consolidated rapidly soon thereafter to offer. While there are previous attempts, the origin of the coverage of the disease in the United States from the date of 1890 to investigate. The first group policy of the employer-sponsored disability incurred in 1911.

Before the development of the insurance costs of treatment, patients are expected to pay out of pocket health care costs, among which is a model business fee-for-service announced. In the mid-20th Century, traditional disability insurance evolved into modern health insurance. Currently, the program is the most comprehensive cost of private health insurance for routine, preventive and emergency, and the drugs most commonly prescribed, but this is not always the case.

Hospital and physician cost-effective measures in the first half of the 20th Century. In the 1920s, individual hospitals began offering services to people on a prepaid basis, eventually leading to the development of Blue Cross organizations. [5], a pioneer of today's Health Maintenance Organizations (HMOs) originated beginning in 1929 through the 1930s and during the Second World War.

How it works

Health insurance is a contract between an insurance company (such as insurance companies or the government) and individuals or sponsors (eg employers or nonprofit organizations). Contracts can be extended (eg annual, monthly) or a lifetime in the case of private insurance or compulsory for all citizens in this national plan. The type and quantity of health care costs covered by health insurance in writing to the Member States of the contract or "Evidence of Coverage" book for private insurance or national health insurance to the public.

Liability insurance can take various forms:

• Premium: The amount you pay to buy the policy holder or the sponsor (employer) to the health plan to health insurance.
• Deductible: The amount paid, the insured out of pocket before the insurance pays its part. For example, over policyholders up to $ 500 deductible per year for their medical care by health insurance. It may take several visits to the doctor or limit the prescription to the insured person reaches the deductible and the insurance to pay for medical care.
• Co-payment: The amount payable by the Insured out of pocket before the insurance pays for a particular visit or service. For example, to the insured to pay $ 45 copayments for doctor visits or prescriptions. A co-payment each time a paid service.
• Co-insurance: In place of or in addition to paying a fixed amount (cost), co-insurance percentage to pay the total cost of the insured. For example, members can have 20% of operating costs and additional costs, while insurance pays the remaining 80%. If there is a limit to the co-insurance, the policyholder can end up as little or much, depending on the actual cost of services they receive.
• Exceptions: Not all services. Insurance is generally expected that the full cost will be paid by the non-covered services out of pocket.
• Coverage limits: Some health insurance companies only pay for healthcare for a specific dollar amount. Uninsured people, estimated at no cost, is the maximum payout for a particular service is greater than the health plan pays. In addition, some insurance coverage of the annual or lifetime maximum. To stop in this case, the health plan benefits for the maximum benefit of policyholders and to reach all other costs.
• Out-of-pocket maximum: Similar to coverage limits, except those ending in this case, the payment of the insured when it comes to the maximum out-of-pocket cost of health insurance and get paid more closed. Out-of-pocket maximum of a certain service category (eg drugs), or may be limited due to its coverage of all special services for one year.
• Amount: An amount paid by health insurance, the provider undertakes to treat all members of the insurance.
• In-Network Providers: (U.S. name), a provider of health care providers on the list are selected by the insurance. Insurance companies offer discounted co-insurance or co-payment or additional services to look for the plan to the members of the network provider. Network providers generally pay providers who contract with insurance companies at a discount, more than the cost of the "usual and customary" insurance will receive out-of-network provider.
• Prior authorization: A certification or licensing of health insurance before they occur. The granting of a license means that the insurer must pay for this service in accordance with what is permitted. Many minor routine services are not subject to approval.
• Explanation of Benefits: A document from the insurance company to the patient what will be covered for medical benefits proposed to explain how the payment and the amount of the patient determines the responsibility.

Prescription Drug Plan is a form of insurance offered by some insurance companies. In the U.S., patients are usually additional costs and health insurance or your entire balance under the plan drug formularies. The plan is an integral part of national health insurance. For example, in Quebec, is universally required for drug insurance, as a part of public health, but can be purchased and managed private or group lessons lesson plans, or with the general plan.

Some if not most, will, health care providers in the United States to carry out insurance bill, if the patient willing to covenant that they will not be responsible for signing the amount you pay for insurance. The insurance company pays the network operator "reasonable and customary" fees that can cost less than regular provider. Providers can also set individual contracts with insurance companies, bank rate or the amount of the provider, which costs the standard. It costs the patient less in-network operators in common use.

Health Planning vs. Health Insurance (United States)

Historically in the United States. HMOs tend to use "health plan" for use, while commercial insurance companies use the "health insurance" long. A health plan is an arrangement of subscription-based medical care to HMO, preferred provider organizations or point of reference of available subscriptions. This plan is similar to the teeth, Pre-Paid Legal vision, pre-paid and prepaid plans. Pre-paid health plans typically pay for some services (eg $ 300 in prevention, a number of day hospital treatment or care in a nursing home, a fixed number of home health visits, a fixed number of spinal manipulation costs etc). Services offered are usually at the discretion of a nurse research utilization, often through the agency managed health care plan subscription contract. This provision can be made before or after hospital admission (concurrent use review).

Comprehensive vs. scheduled (U.S.)

Comprehensive health insurance pays a percentage of the cost of hospital and medical expenses after the deductible (usually applies to hospital costs) or co-pay (usually applies to physicians can reduce costs, but it applies to a particular hospital services) is defined by the policyholders are met . This plan is usually the result of the potential benefits of high payment - $ 1000000-5000000 is common - and by a lot of services covered.

Health insurance plan is not intended as a traditional comprehensive health insurance plan to replace more than the basic policy of access to day-to-day health care such as going to the doctor or prescription drugs. In the last few years in the U.S., these plans are called mini-med plans or plans to change the club. The term "association" is often used to describe, because membership in an association, the request must be sold for purposes other than insurance. Examples include the Health Care Credit Union Association. This plan can provide benefits for hospitalization and surgery, but this benefit is limited. The planned schedule is not intended to be effective for catastrophic events. This plan is cheaper than a comprehensive health insurance. They generally pay a limited amount of direct benefit to the provider, and payment plans are based on the annual benefit limit "schedule of benefits." For a typical health insurance plans can range from $ 1,000 to $ 25,000 range.

Other factors that insurance rates (United States)

A recent study by PriceWaterhouseCoopers examining the drivers from the rising cost of health care in the U.S. pointed to increased utilization due to increased consumer demand, new treatments and diagnostics are intense, as the most important. [13] However, Wendell Potter, a long time PR representative for health insurance, found that the group that sponsored the study, AHIP, the front group funded by various insurance companies. [14] People in developed countries live longer. Residents of these countries is aging, and a larger group of senior citizens requires more intensive medical care as the population, healthy young. Advances in medicine and medical technology, medical care costs. Lifestyle factors that affect the use and therefore insurance prices, such as increasing: increasing obesity through activity and unhealthy eating habits lead to excessive alcohol consumption, smoking and drug use. Other factors, as noted by the PWC study on the movement of broad access plan, expensive technology and cost-shifting from Medicaid and private sector must be insured.

Other researchers suggest that physicians and other caregivers (HCPS) only for the treatment of patients rather than himself and that patients can be cured through BKV insured have an incentive to HCPS absolute best not the cheapest that would be appreciated.