When people get ill or injured, medical expenses can sometimes
be unaffordable. These are the times when health insurance helps.
Questions such as Is the scheme suitable for me and Does the
scheme cover only medical expenses or something more spring
to ones mind before deciding any particular health insurance
coverage. This article addresses important questions like these
and many more so that the reader will have a good idea of what
Texas health insurance is, how best to use it and where to find
Texas health insurance.
What is health insurance
Texas health insurance is a process
based on a written agreement between a person and a Texas health
insurance such that the insurance company will pay a part or
all of a persons medical expenses in the event of illness or
The term also refers to insurance policies used (i) to cover medical expenses incurred due to a range of healthcare situations and (ii) to compensate for any disability or loss consequent to ill health or injury.
Types of health insurance plans:
Fee for Service: In this type, the patient can consult any doctor according to his choice, and obtain treatment. The insurance company provides reimbursement only for covered medical expenses that are listed in the beneficiarys benefits summary. The company may reimburse part or full cost depending upon the provisions laid down in the insurance policy with particular emphasis on coinsurance and deductibles. Most Fee for Service policies cover 100 per cent of medical bills that are within what is termed as reasonable and customary limits. Some policies reimburse 80 per cent of the bills. The remaining 20 per cent, known as coinsurance, is borne by the patient.
If the cost is more than the reasonable and customary limit, the patient bears the additional cost. For example, if a doctor charges $100, the insurance company will reimburse $80 and the patient will pay $20. If on the other hand, the doctor charges $115, the company will reimburse the same $80 and the patient will pay $35 ($20 plus the additional fee of $15).
Deductibles are the medical expenses borne by the patient each year before getting the reimbursement from the insurance company. If the deductibles are more, the insurance premium would be less.
There are three main types of managed care plans. They are Health Maintenance Organizations (HMO) Plan, Preferred Provider Organizations (PPOs) Plan, and Point-of-Service (POS) Plan. In many instances, managed care plans provide both medical coverage and healthcare. Instead of reimbursing medical expenses for each service separately, managed care offers what is known as prepaid care, that is, financial relief in advance, to its members.
Health Maintenance Organizations Plans are basically useful to patients when they consult doctors who are members of the HMO network. PPOs and POS plans are packages featuring a combination of fee-for-service and HMOs.
Self-insured Plans are provided by an employer to cover health care expenses of the employees.
Medicare is a federal program meant for people who are 65 years and older, for others who suffer from certain disabilities, and all people with end-stage renal problems.
Long-term care policies cover medical care, nursing, and other exclusive services offered for a chronic illness or disability that leaves a person unable to care for him self over an extended period of time. Most long-term care policies pay from approximately $40 to $200 a day for service in a nursing home. Some long-term care expenses and insurance premiums are tax deductible.
Disability insurance provides some income if illness or injury prevents a person from being able to work for an extended period of time.
Medicaid is a state-administered health insurance program catering to low-income individuals and families who meet specific requirements of age, disability, income and U.S. citizenship or residency status.
Post employment health coverage:
Group Health Plans cater to people who leave employment, and
are applicable to establishments with 20 or more employees.
According to the Consolidated Omnibus Budget Reconciliation
Act of 1985, (commonly known as COBRA), Group Health Plans offer
continued Texas health insurance
coverage for the employee and his/her dependents for 18 months
after leaving job. This law applies only to people who leave
employment due to a "qualifying event. [For instance, if a person
is fired for misconduct, he is not entitled for continuation
of health insurance].
If the employee dies or divorces, his/her family has the right to get the coverage for up to three years. However, if a person likes to continue group coverage under this option, it must be notified to the employer within 60 days and the person must pay the entire premium, that is, up to 102 percent of the cost of the coverage.
As Group Insurance caters to more number of people, it cuts down administrative
costs. This results
in lower insurance premiums. If an employee moves to a smaller
organization with less than 20 employees, where COBRA is not
applicable, he can convert to individual insurance. The main
advantage in this transfer option is that the person may not
need to pass a medical exam, unless in exceptional circumstances
defined by the persons medical and Texas
health insurance history.
Individual insurance is also suited to people who are self employed, or work in small organizations which dont have a health insurance plan. As individual insurance policies are often tailor made to suit individual needs, comparison of costs and benefits offered by different insurance companies is a must.
Short-term or Interim policies cater to people with a short-term need, such as those who are temporarily between jobs or those moving from college to a job.
These policies, which are normally of two to six months duration and renewable once, cover expenses incurred in hospitalization, intensive care, surgical and doctors' care provided in a hospital and related services such as X-rays or laboratory tests provided out side hospitals. Some policies provide an option to return the policy within 60 days and get the money refunded, if the consumer finds the policy not suitable to his needs.
What to look for in health coverage
The three most important factors which should be considered
when selecting a health insurance policy are
1. Medical services that are covered
2. Benefits offered
3. The amount that the patient is expected to pay in deductibles and coinsurance
Health Insurance Providers in Texas:
If you want to locate Health Insurance Providers in Texas, Yellow pages are an excellent source of information Texas health insurance. By using Yellow pages, you can browse the company websites and get all the relevant details. The best way to understand the terms and conditions associated with a policy is to read the policy itself instead of marketing or sales literature. It is advisable to know the insurance company's rating in the insurance industry. The National Association of Insurance Commissioners is a good source of information to know the financial standing of insurance companies.
As in any other areas of finance, it is important to window-shop, compare
different plans and then decide on the most suitable plan for
you and your family.
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