Health insurance: understanding what it covers for Inspiring life-1

Health insurance: understanding what it covers

Your health insurance policy is an agreement between you and your insurance company. The policy contains a package of medical benefits, such as tests, medications, and treatment services. The insurance company agrees to cover the cost of certain benefits established in your policy. These are called “covered services.”

Your policy also establishes the types of services that are not covered by your insurance company. You must pay for any non-covered medical care you receive.

The path to better health

How do I know what services are covered?

If you already have an insurance plan and want to keep it, check your benefits to see what services are covered. Your plan may not cover the same services as another plan. You should also compare your plan with those offered through a Health Insurance Marketplace. The Health Insurance Marketplace is a service that helps you purchase and compare health insurance plans. It is operated by the federal government.

Essential health benefits

Most insurance plans will cover a set of preventive services at no cost to you. This includes vaccinations and certain health tests. If you purchase a plan through a Health Insurance Marketplace, your insurance will cover preventive services. It will also cover at least 10 essential health benefits required by the Affordable Care Act (ACA). All private health insurance plans offered in federally facilitated markets will offer the following 10 essential health benefits:

• Outpatient patient services (outpatient care you get without being admitted to a hospital)
• Emergency services
• Hospitalization (such as surgery)
• Maternity and newborn care (care before and after your baby is born)
• Mental health and substance abuse disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
• Prescription drugs
• Rehabilitation and habilitation services and devices (services and devices to help people with injuries, disabilities or chronic conditions obtain or regain mental and physical abilities)
• Laboratory services
• Preventive and wellness services and chronic disease management
• Pediatric services

State-run markets will also need to offer the top 10 essential health benefits, but the list of benefits may differ from that offered by federally-provided markets. Plans may offer additional coverage.

Preventive services

Preventive services can detect disease or help prevent disease or other health problems. The types of preventive services you need depend on your gender, age, medical history, and family history. Some preventive services covered by the ACA include blood pressure tests, cervical cancer screenings, HIV screenings, vaccinations, and follow-up visits for women. Coverage for preventive services also varies by state, so please review covered services carefully before choosing a plan.

What is a medical necessity? Is it different from a covered service?

Please note that a medical necessity is not the same as a medical benefit. A medical necessity is something that your doctor has decided is necessary. A medical benefit is something that your insurance plan has agreed to cover. In some cases, your doctor may decide that you need medical care that is not covered by your insurance policy.

Insurance companies determine what tests, medications, and services they will cover. These options are based on your understanding of the types of medical care that most patients need. Your insurance company’s decisions may mean that the test, drug, or service you need is not covered by your policy.

What should I do?

Your doctor will try to familiarize you with your insurance coverage so that we can provide covered care. However, there are so many different insurance plans that your doctor may not know the specifics of each plan. By understanding your insurance coverage, you can help your doctor recommend medical care that is covered by your plan.

• Take the time to read your insurance policy. It is best to know what your insurance company will pay before receiving a service, getting tested, or filling a prescription. Some types of care may need to be approved by your insurance company before your doctor can provide them.
• If you still have questions about your coverage, call your insurance company and ask a representative to explain it to you.
• Remember that your insurance company, not your doctor, makes decisions about what will and will not be paid.

Aspects to consider

What if my doctor recommends care that is not covered by my insurance?

Most of the things your doctor recommends will be covered by your plan, but some may not be. When you are prescribed a test or treatment that is not covered, or you get a prescription for a drug that is not covered, your insurance company will not pay the bill. This is often called “denying the claim.” You can still get the treatment recommended by your doctor, but you will have to pay for it yourself.

If your insurance company denies your claim, you have the right to appeal (challenge) the decision. Before deciding to appeal, learn about your insurance company’s appeal process. It should be included in your plan manual. Also, ask your doctor for his opinion. If your doctor thinks that it is okay to file an appeal, he or she can help you through the process.

Questions for your doctor

• Is there any type of insurance that you do not accept?
• What type of coverage is most important to me and my family?
• Are you on my insurance company’s provider network?

Benefits of private health insurance for employees

One of the main advantages of offering private health insurance is, of course, the satisfaction that employees have in having a specialist doctor available whenever they need it. In the case of health insurance for Factorial employees without deficiencies or copays. A satisfaction that implies a greater commitment to the company and better professional performance and this is not the only thing.

Health insurance allows employees to be treated more quickly and in better conditions than in public health. No endless waiting. In fact, there are also interesting tax savings associated with taking out private health insurance.

In Factorial you will find the best private medical insurance with dental insurance for employees at the best price, without deficiencies or copays. By being able to negotiate volume pricing, we have access to the best deals with the leading insurer. Did you know that health insurance is the social benefit most valued by workers?

Benefits of private health insurance for the company

Initially, it may seem that taking out health insurance for employees is an extra cost for the company, but instead of the cost, it should be seen as an investment in talent due to the positive effect it brings. There are two different ways to offer this product to employees and at a cost from € 0 for the company. The company must take into account that in both cases the cost will be fully deductible in the Corporation Tax (IS).

• Offer it as part of the employee’s salary (flexible remuneration): In this modality, the company offers the possibility to all its employees to include the cost of medical insurance on the payroll. In this way, the employee manages to reduce the amount of personal income tax with the possibility of deducting up to € 500 per year per insured person.
• Offer it as a benefit: In this case, the company assumes the extra cost of medical insurance to the employees to whom it wants to offer it. While flexible compensation requires the company to offer insurance to all employees, if it is offered as a benefit, it could choose which employees to offer it to. Workers who finally accept private insurance as a benefit will also be able to deduct that amount from their personal income tax.

Obviously, in the same way, that for the employee it involves personal benefits (motivation, commitment to the company, higher performance, etc.), this fact also brings benefits to the company. Having motivated, loyal and productive employees results in better overall results for the business.

Requirements to benefit from tax savings

As we mentioned, taking out private health insurance for employees represents a very interesting saving for companies and workers. In this final part of the article we are going to establish what essential requirements must be met in order to qualify for them:

• The basic and essential condition for private health insurance to be fiscally deductible for the company and exempt from taxation for the employee is that it appears as a right assigned to the employee (which is part of the mass of their remuneration) and is reflected in your payroll.
• It is recommended that you sign a document that includes this right.

Fundamental aspects of choosing health insurance

You must bear in mind that when choosing between the different medical insurances, the first step is to specify what health care needs you to have, what type of user you are if you want full coverage, or only for certain services. If a person has a medium purchasing power and is also satisfied with the care they receive from public health for primary care, but want to entrust their health to a private company for more serious situations, they can choose from insurances that only offer hospital care –In case of surgical intervention or hospitalization–.

An example of this type of health insurance would be the case of the Asia Hospitalization policy, which guarantees financial remuneration for each day of hospitalization. On the other hand, users who look to private healthcare only for immediate assistance and without waiting lists in general and specialist medicine can opt for basic policies, which offer primary care – in addition to other coverage – but exclude hospitalization or more specialized treatments, such as the Basic Plus Plan for Collegiate Health Care, or the Basic Sanitas policy.

Types of health insurance

Health insurance, as is the case with a car or life insurance, differ greatly from each other to adapt to the particularities of each client and thus offer the best benefits. Among the most common are Healthcare policies, in which the insured receives services and coverage within a group of professionals and concerted centers of the company

Which health insurance is most recommended?

Before opting for health insurance or another, it is important that you stop to think about what coverage and what services you will really need. Do you travel a lot abroad? You are interested in having international healthcare. Do you intend to have children in the future? Carefully observe the services that the company offers in relation to pregnancy, childbirth, and postpartum.

Obviously, we must also think in our pockets. However, it is essential that we do not dispense with essential coverage in order to get the cheapest insurance. For this reason, from Acierto.com we recommend that you compare the different offers that companies present so that you find the most suitable price for your needs.

To save on your private health insurance, you can opt for a policy with basic coverage, which covers medical consultations but does not usually include hospitalizations or diagnostic tests. Although it is not the most complete policy, you can enjoy the advantages of the speed of private healthcare, as well as the best professionals and the highest technology.

In the event that you want to have more complete insurance, you can consider the option of contracting it with a copayment, and enjoy some coverage that is not in the most basic medical insurance such as dental. In this way, you will be able to access a greater number of services by paying part of their cost each time you use them. If you prefer to have the peace of mind of knowing what you are going to pay each year, you can eliminate the copays – that is, assuming a higher premium.

Check your conditions before each annual renewal

The automatic renewals for years that companies do bring a lot of comfort to the client, but in many cases, they can be an opportunity to improve the price of health insurance. In fact, the premium may increase, but being automatically renewed we may not realize until it is too late.

For this reason, we recommend you compare the different offers before renewing your policy. It is a fantastic possibility to save, since the conditions (both the market and your own) may have changed from one year to the next. It is important, however, to take into account that if you decide to terminate the contract you will have to notify the company at least one month in advance. In this case, you must also ensure that your new company does not apply deficiencies to you as it comes from another insurer and that it does not apply exclusions of possible ailments that instead are covered in your current policy.

What should I take into account before purchasing health insurance? Limits, gaps, and copays

The limits of health insurance is a very important part that we should not forget when contracting a policy with any company. Probably the most important limit is the number of days of hospitalization. Typically, companies cover certain days that can vary between the 30s and 90s. In the unlikely event that you were to spend more than the 30-90 days stipulated in a year in the hospital, depending on the company, expenses could be out of pocket.

In this way, there are also other limits and exemptions that, although they are less common, it is important to know them. Health insurers often do not cover damage caused in war situations, in officially declared epidemics, and in nuclear or radioactive catastrophes.

Another factor to consider its deficiencies. This element is especially important when we talk about pregnancy. Companies usually establish a grace period of between 8 and 24 months for everything related to pregnancy and, even, we can find insurers that do not offer health insurance to an already pregnant woman. There are also usually 6-month grace periods for hospital stays and surgical interventions.

How to select the best company for health insurance?

Choosing a company to purchase health insurance is not a minor issue. We must not forget that we are talking about your health and that of yours, so it is essential to hit the insurer right from the start. So we want to give you some advice to help you with this choice.

First, we must look at the company’s experience in the health insurance sector. Ideally, if your company offers you adequate financial and coverage conditions each year, the safest thing is to stay with the same health company for life, to avoid that, in the change of company, the new insurer does not cover any medical condition. acquired. Therefore, the most advisable thing is to bet on a company specialized in Health, with proven great stability and a long history of benefits, which give you the assurance that it will not disappear in the next 10 or 20 years. From this point of view, opting for new insurers or specialized insurance policies, for example, in car insurance, but with little health, is not recommended.

And it is that the analysis must go beyond their own experience. It is important to check the professionals that make up your medical chart, as well as the hospitals and centers arranged with the company. At this point, it is also relevant to observe which of these centers and professionals are close to our home. Finally, you should study the customization options offered by the company, since only then can you get the private health insurance that best suits your needs and your pocket.

There are three types: the Medical Chart Policy, which gives access to unlimited medical services within the insurer’s medical chart. In this type, there are two modalities: with a copay and without a copay.

The Insurance Doctors Without Hospitalization, which are the most economical option because it does not cover hospital stays or surgeries that require them.

The Reimbursement Medical Insurance, where the insured can choose any hospital center, and each time he goes to the doctor, he must pay the price of the visit. Subsequently, your company will refund the agreed amount (may be total or partial).

Health insurance: understanding what it covers

Your health insurance policy is an agreement between you and your insurance company. The policy contains a package of medical benefits, such as tests, medications, and treatment services. The insurance company agrees to cover the cost of certain benefits established in your policy. These are called “covered services.”

Your policy also establishes the types of services that are not covered by your insurance company. You must pay for any non-covered medical care you receive.

How to select the best company for health insurance?

Choosing a company to purchase health insurance is not a minor issue. We must not forget that we are talking about your health and that of yours, so it is essential to hit the insurer right from the start. So we want to give you some advice to help you with this choice.

First, we must look at the company’s experience in the health insurance sector. Ideally, if your company offers you adequate financial and coverage conditions each year, the safest thing is to stay with the same health company for life, to avoid that, in the change of company, the new insurer does not cover any medical condition. acquired. Therefore, the most advisable thing is to bet on a company specialized in Health, with proven great stability and a long history of benefits, which assure you that it will not disappear in the next 10 or 20 years. From this point of view, opting for new insurers or specialized insurance policies, for example, in car insurance, but with little health, is not recommended.

And it is that the analysis must go beyond their own experience. It is important to check the professionals that make up your medical chart, as well as the hospitals and centers arranged with the company. At this point, it is also relevant to observe which of these centers and professionals are close to our home. Finally, you should study the customization options offered by the company, since only then can you get the private health insurance that best suits your needs and your pocket.

There are three types: the Medical Chart Policy, which gives access to unlimited medical services within the insurer’s medical chart. In this type, there are two modalities: with a copay and without a copay.

The Insurance Doctors Without Hospitalization, which are the most economical option because it does not cover hospital stays or surgeries that require them.

The Reimbursement Medical Insurance, where the insured can choose any hospital center, and each time he goes to the doctor, he must pay the price of the visit. Subsequently, your company will refund the agreed amount (may be total or partial).

Five tips to take out private health insurance

To purchase private health insurance for the first time, it is important to take the time to make the decision. You have to be very clear about what you are going to pay and the services they can offer you. To avoid mistakes, at CuidatePlus we review things to know before taking out insurance.

Coverage

It is a very common mistake to believe that private health insurance covers everything and, often, when it is time to pay at the end of the month, surprises appear. Before hiring, you have to know what that insurance covers: hospitalizations, diagnostic tests, treatments…The grace periods

This is the time until a healthcare service can be used. Before deciding, it is good to compare the different grace periods between insurers. It is also important to check whether they exist during pregnancy or convalescence.

With or without a copay

The copayment is the amount paid for the use of medical service. Some companies already have them included in the monthly amount, however, others charge them for each use.

The medical chart

Insurers have a wide range of specialists and, sometimes, they give the option of having the insured person choose the doctor.

Services abroad

When traveling, you never know what may happen and, if you need a medical service outside the country of residence, there are insurers that do include it, but others do not.

Dental insurance

Oral health is usually a service that insurers do not include. If you want to contract, the cost will vary depending on the company.

Despite reading the fine print, something always escapes. So that there are no doubts when contracting, private health insurance comparators compare all the offers making the choice faster and more effective. An example of comparators is iSalud, which offers a wide variety of options to choose the most suitable one. 

Addison

Addison is a student of the Aust Abbottabad University of Science and Technology. He started his graduation in 2016 and graduated in 2020. I’m a professional article and blog writer, has written dozens of content on different topics and worked with professionals all over the globe. Feel free to contact me for any assistance. [email protected]