Health Insurance

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What is Health Insurance?

Health Insurance is a contract where individuals pay regular premiums in exchange for coverage of medical expenses. It helps cover costs such as doctor visits, hospital stays, and prescription medications, depending on the plan and its benefits. This essential coverage ensures that you have financial support for necessary healthcare services.

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Network-based Health Benefits Plans

Types of Plans:

Network-based health benefits plans include PPO, POS, and EPO options, each designed to suit different healthcare needs. PPO and POS plans offer the flexibility to use both in-network and out-of-network providers, with greater benefits for in-network services. EPO plans require the use of in-network providers except in emergencies, often requiring a primary care physician to coordinate care. These plans ensure that members receive high-quality care while managing costs effectively.

• HMO: Requires use of network providers except for emergencies and urgent care.
• EPO: Covers only in-network services except in emergencies, often needing a primary care physician.
• PPO: Provides coverage for both in-network and out-of-network providers, with lower out-of-pocket costs for in-network services.
• POS: Similar to PPO, but may require referrals for certain services and includes out-of-network coverage.
  

Key Terms in Health Insurance

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Deductibles:

The amount you pay before your insurance starts to cover expenses.

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Coinsurance:

The percentage of costs you share with your insurer after meeting the deductible.

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Copayments:

A fixed amount you pay for specific services or visits.

04

Maximum Out-of-Pocket (MOOP):

The maximum amount you pay in a year before your insurance covers 100% of services.