HEALTH INSURANCE BENEFITS
Specific health care benefits may vary by state. Even within the same state, there can be small differences between health insurance plans. When you fill out your application and compare plans, you’ll see the specific health care benefits each plan offers.
Investment in a health insurance plan is investing for the protection and wellness of an individual and his/her family health, depending upon the plan opted for. The word ‘protection’, here, means the financial security in case of an unexpected or exigent situation. The word ‘wellness’ stands for the recommendation or advice offered to clients by experts. In case of exigencies, one can rely on the insurance company to endure his/her expenses. But, it is always advisable to buy from the leader as they are worth relying upon.
No one plans to get sick or hurt, but most people need medical care – like a doctor visit, a prescription drug, a lab test, physical therapy, or counseling – at some point. These services can be expensive.
And if something happens that requires surgery or emergency medical care, it’s really important to have coverage. Fixing a broken leg can cost up to $7,500, and the average cost of a 3-day hospital stay is around $30,000.
The Health Insurance Marketplace offers a variety of high-quality health coverage choices for routine and non-routine medical services that can work for one’s family and budget.
Every health insurance plan sold in the Marketplace will offer the following essential health benefits.
These essential health benefits include at least the following items and services:
- Outpatient care—the kind one gets without being admitted to a hospital.
- Trips to the emergency room.
- Treatment in the hospital for inpatient care.
- Care before and after one’s baby is born.
- Mental health and substance use disorder services: This includes behavioral health treatment, counseling, and psychotherapy.
- Your prescription drugs.
Services and devices to help an individual recover if he/she is injured, or has a disability or chronic condition. This includes physical and occupational therapy, speech-language pathology, psychiatric rehabilitation, and more.
- Your lab tests.
- Preventive services including counseling, screenings, and vaccines to keep an individual healthy and care for managing a chronic disease.
- Pediatric services: This includes dental care and vision care for kids.
Benefits even before you meet your deductible
In the Marketplace, all plans cover some services – like preventive care and well-woman visits – for free.
Some plans offer other health insurance benefits – like reduced price generic drugs and free disease management programs.
If a member gets medical services from a provider in his/her plan’s network, he/she will pay lower prices than he/she would without insurance. That can save the individual hundreds of dollars per year.
One of the benefits of health insurance through the Marketplace is that all health insurance plans cover the same set of essential health benefits, even for a pre-existing health condition. In addition to coverage for doctor visits, lab tests, hospitalization, surgery, and emergency care, here are a few more: Pregnancy, maternity, and newborn care before and after one’s baby is born. The individual gets this coverage even if the individual was pregnant before her coverage starts. Most plans also provide breastfeeding benefits, Preventive services for adults, children, and women. Women’s preventive services include well-woman visits and contraceptive care, Mental health and substance abuse services, including behavioral health treatment like counseling and psychotherapy Prescription drugs.
Broadly speaking, health insurance policies are of two types – indemnity-based and fixed benefit-based.
- Don’t Pay for Your Hospitalization
A member can avail cashless health insurance (indemnity-based) at networked hospitals of insurance companies. It means that he/she will not have to pay the medical expenses at these hospitals. The insurance company settles them on his/her behalf.
This facility is a boon for patients as they do not incur out of their pocket expenses, freeing them up from the unnecessary mental burden and enables them to concentrate on recuperation and rehabilitation.
- Get a Convalescence Benefit
Some health insurance plans offer a daily amount for each day of hospitalization. Do not worry about keeping records of the amount actually spent to claim this daily cash. The daily cash amount does not depend upon the amount actually spent.
One can also opt for Convalescence benefit in his/her health insurance policy. Such a cover pays him/her a lump sum amount if hospitalization exceeds a certain number of days.
- Safeguard Your Finances and Avail Tax Benefits
A comprehensive health insurance policy with an adequate sum assured can help a member meet unplanned health care expenses so that he/she do not have to dig into his/her savings or reroute his/her income. One can also avail pre-defined tax benefits by paying health insurance premiums.
- Cover for Life-Threatening Critical Illnesses
The fixed pre-defined benefit type of medical insurance policies provides a fixed lump sum payment upon diagnosis and confirmation of certain critical illnesses like cancer, stroke, paralysis, kidney failure, etc. Irrespective of the actual amount spent by the insured, he or she receives the lump sum amount which can be used to fund rehabilitation, recuperation, lifestyle adjustment, etc.
- Get Allied Benefits
Health care system in India has evolved with preventive health check-ups and improved diagnostics. Certain progressive insurance companies offer benefits that are generally not associated with health insurance policies. Some such benefits are:
- Consultation with nutritionists
- Free health check-ups
- Tie-ups with health service providers
- Free Consultation with doctors
- Discounts Coupons on healthcare services
Rising healthcare costs can punch a big hole in your pocket. Paying a small health insurance premium is the simplest way to mitigate the financial losses and to achieve peace of mind. Avail health insurance to save yourself from worries of hospitalization.
Investment in a health insurance plan is investing for the protection and wellness of you and yours family health, depending upon the plan opted for, there are lots of essential benefits, especially saving the member from high-rated expenses.