Health Insurance Link :
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About This Video :
Health insurance is a type of coverage that pays for medical, hospitalization, and surgical expenses incurred by the insured. It can also cover some or all of the costs for things like doctor visits, prescription medications, diagnostic tests, and preventive care (such as vaccinations or screenings).
Health insurance can be purchased privately or provided by employers or government programs (like Medicare or Medicaid in the U.S.). Typically, policyholders pay a monthly premium, and they may also need to pay deductibles, co-pays, or coinsurance when receiving medical care.
The main purpose of health insurance is to help individuals avoid high medical costs by sharing the financial risk of medical treatment. This can make healthcare more affordable, especially in the case of serious illnesses or injuries.
In health insurance, there are several important terms you should understand. These terms can help you navigate your policy, know what to expect in terms of coverage, and manage your healthcare costs. Here are some key terms in health insurance:
1. Premium
The amount you pay regularly (monthly, quarterly, or annually) to keep your health insurance policy active. This is usually paid by the insured person or through their employer if they have employer-sponsored coverage.
2. Deductible
The amount you must pay out-of-pocket for covered healthcare services before your insurance starts to pay. For example, if your plan has a $1,000 deductible, you’ll need to pay that amount for services before your insurer covers the rest of the costs.
3. Co-payment (Co-pay)
A fixed amount you pay for a covered healthcare service, usually at the time of the service. For example, you might pay a $20 co-pay for a doctor’s visit, and the insurance covers the rest.
4. Coinsurance
The percentage of costs you pay for a healthcare service after you’ve met your deductible. For example, if your coinsurance is 20%, and you have a medical bill of $1,000 after the deductible, you’d pay $200, and the insurer would pay the remaining $800.
5. Out-of-Pocket Maximum (OOPM)
The maximum amount you will have to pay for covered healthcare services in a policy period (usually a year). After reaching this limit, your insurance will cover 100% of your medical costs for the rest of the year.
6. In-Network vs. Out-of-Network
In-Network: Healthcare providers that have agreements with your insurance company to provide services at a reduced rate.
Out-of-Network: Healthcare providers that do not have an agreement with your insurance. If you see an out-of-network provider, you’ll typically have to pay higher out-of-pocket costs.
7. Pre-Hospitalization (Pre-Hospitalization Expenses)
These are medical expenses incurred before being admitted to the hospital for treatment. Health insurance plans often cover pre-hospitalization costs related to the diagnosis and treatment of the condition that leads to hospitalization. The coverage typically has a time limit (e.g., 30 days before hospitalization).
8. Post-Hospitalization (Post-Hospitalization Expenses)
These are medical expenses incurred after being discharged from the hospital for further treatment, recovery, or rehabilitation. Health insurance policies often cover these expenses for a certain period (e.g., 30 days or 60 days after discharge), depending on the plan.
9. Waiting Period
The time you must wait before certain health benefits become available under your insurance plan. This can include waiting for coverage on pre-existing conditions or for specific treatments like maternity care.
10. Exclusions
Services or conditions that are not covered by your health insurance policy. Common exclusions may include cosmetic surgeries, certain treatments not deemed medically necessary, or treatments for pre-existing conditions (in some cases).
11. Cashless Facility
This allows you to receive medical treatment at network hospitals without having to pay out-of-pocket. The hospital directly bills the insurance company, and you pay only the deductible, co-payment, or any non-covered costs.
12. Network Hospitals
Hospitals and healthcare providers that have an agreement with your insurance company to provide services at a discounted rate. These hospitals are often the ones you can use for cashless claims.
13. Daycare Procedures
Medical treatments or surgeries that require less than 24 hours of hospitalization. These procedures are often covered by modern health insurance policies, even if you’re not admitted to the hospital overnight.
14. No Claim Bonus (NCB)
A reward or discount given by insurance companies to policyholders who have not made any claims during a policy year. This is often in the form of a higher sum insured or a reduced premium for the next year.
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