Medical insurance is an insurance that provides financial protection against the risk of incurring medical expenses. A company can design a regular finance structure by estimating the overall risk of health expenses such as a monthly premium or pay roll tax to ensure the amount is paid regularly. The paid benefit is administered by a government body or a non-profit organization. Medical insurance is defined as ‘coverage that provides for the payments of benefits as result of sickness or injury. It includes insurance for losses from accident, medical expense, disability, or accidental death or dismemberment.’
Medical insurance policy in India usually pays only for the inpatient hospitalization and treatment in India itself. Outpatients covers are not payable under health policies in India. This policy is a contract between the company and the insured. The contract can be renewed or can be retained lifelong in case of private insurance. The type and amount for health care and expenses that will be covered in writing are specified in writing.
People often find it difficult to choose the right medical insurance plan. This happens because the market is constantly changing and the coverage plans are hard to categorize. There are various forms of medical insurances like HMO, PPO, PSO. The differential lines of these policies are often blurry and people often get confused between these plans. In a very general sense, HMOs offer predictable cost-sharing and administrative simplicity for patients. These features come with fairly restrictive rules about which providers patients may see. Participants are entitled to doctor visits, preventive care and medical treatment from providers who are in the HMO’s network.
HMOs typically require patients to select a “primary care physician” who can refer patients to specialists, also within the HMO’s network. HMOs often won’t pay for medical care that wasn’t referred by the primary care physician. They may also require prior authorization before elective hospitalizations or require referrals from primary care physicians before seeing certain specialists.
PPOs generally offer a wider choice of providers than HMOs. Premiums may be similar to or slightly higher than HMOs, and out-of-pocket costs are generally higher and more complicated than those for HMOs. PPOs allow participants to venture out of the provider network at their discretion and do not require a referral from a primary care physician. However, straying from the PPO network means that participants may pay a greater share of the costs.
A POS is a type of managed care plan that is a hybrid of HMO and PPO plans. Like an HMO, participants designate an in-network physician to be their primary care provider. But like a PPO, patients may go outside of the provider network for health care services. When patients venture out of the network, they’ll have to pay most of the cost, unless the primary care provider has made a referral to the out-of-network provider, in which case, the medical plan will pick up the tab.
Considering the above mentioned facts, it is not a brain stresser that medical insurance is a must in today’s times. Considering the medical and health expenses that have gone up, medical insurance provides the best protection required for your family.
