Health insurance may cover certain pharmacy expenses.
Health insurance is coverage that provides financial protection against the development of an event that generates medical expenses . The type of contingency covered and the amount awarded depends on the characteristics of the contract.
This type of insurance policy provides protection against previously specified health risks. It can cover hospitalization , surgery , prescription medications , or specialized care , to name a few.
Features of health insurance
Health insurance is part of the so-called personal insurance , which protects against events that may affect integrity, well-being or even life. In this way it differs from property insurance , aimed at property (house, car, etc.) and civil liability.
Life insurance, retirement insurance and funeral insurance are other personal insurance. In the specific case of health insurance, in many regions it usually works as a complement to the public system, prepaid medicine companies and social works .
Health insurance is usually individual and generally includes compensation that is granted after presentation of the necessary documentation.
Sometimes, the payment of the insurance premium also includes some type of medical coverage, transfers and other benefits. It can also speed up the time it takes to receive a diagnosis or start treatment .
Maternity and childbirth are not usually included in health insurance.
Scope and limitations
The scope and limitations of health insurance depend on the type of policy. Typically, there are different levels of coverage , with premiums that grow as benefits are added.
While there are exceptions, health insurance generally does not cover chronic or pre-existing conditions . This means that if someone who suffers from diabetes takes out insurance of this type, the coverage will not include the expenses linked to said condition.
Injuries from practicing risky sports , pregnancy , organ transplants and cosmetic surgeries are also not usually contemplated in these plans. In any case, it is always important to consult all the available options, since the same insurer may have a plan that does not cover a certain condition but another that does provide coverage for the same case.
Hypertension and other chronic diseases may not be part of health insurance coverage.
Types of health insurance
Health insurance can be classified in different ways. Although the specific characteristics depend on each country, in a broad sense a distinction is made between the following types of insurance, whose acronyms come from the English language since it is the categorization used in the United States :
- HMO (Health Maintenance Organization): They operate with a local network of health centers and doctors available to the insured, who must select from there a primary care provider (who will be in charge of referring specialists who are part of the network) . Usually these insurances work with co-payments.
- PPO (Preferred Provider Organization): Its network is much broader than in an HMO health insurance and also provides access to external professionals, although with additional payments. It does not require the choice of a primary care provider and allows consultation with specialists without referral.
- EPO (Exclusive Provider Organization): They work with a network and provide external coverage only in emergencies . If the insured goes to a center that is not part of the network and it is not an emergency, they must pay the full amount of the service.
- POS (Point of Service Plans): Combines PPO and HMO insurance benefits. To consult specialists, a referral is required.
In other countries, this classification is not common. If we take the case of Argentina , health plans are framed in the benefits of social works (which are financed with contributions from employers and workers) and prepaid medicine (companies that market medical and assistance services through providers). , in addition to the public health system (free care). Generally, those who have the financial possibility hire a prepaid medicine company even if they have the possibility of receiving care in the public system and even if they also have social work.
Health insurance, in this framework, is coverage that allows access to a sum of money in case of certain health problems. Thus, they make it possible to reduce medical expenses. On the other hand, if the person travels abroad, they need to take out travel insurance that covers possible medical emergencies that arise during their stay outside the country.
Its operation
Recognizing that there may be differences depending on the country and the plan chosen, broadly speaking, health insurance works as follows:
- The insured pays a monthly premium , which is the price they must pay to have coverage.
- Many times at the beginning there is a deductible or deductible , which is an amount that must be paid until the plan begins to share the costs contemplated in the policy.
- With the active plan, there is generally coinsurance : the insurer covers a percentage of the expenses, while the insured must assume the rest.
- Certain benefits are covered at 100% , meaning that the insured in those cases does not have to pay anything (beyond the premium). Vaccination and preventive medicine are usually included with this modality.
- Sometimes, the insurance includes additional benefits at no extra charge, such as fitness and well-being programs or health education actions.