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HomeHomework Helphealth-educationHealth Insurance Coverage

Health Insurance Coverage

The various types of expenses and treatments covered under a health insurance policy, including hospitalization, medical treatments, ambulance services, and other related expenses, as well as the terms and conditions of the coverage

beginner
2 hours
Health Education
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Overview

Health insurance coverage is essential for managing healthcare costs and ensuring access to necessary medical services. It helps individuals avoid high out-of-pocket expenses and provides financial protection against unexpected health issues. Understanding the different components of health insuranc...

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Key Terms

Premium
The amount you pay for your health insurance every month.

Example: You pay a premium of $200 each month for your health insurance.

Deductible
The amount you pay out-of-pocket before your insurance starts to pay.

Example: If your deductible is $1,000, you must pay that amount before coverage kicks in.

Copayment
A fixed amount you pay for a specific service, like a doctor's visit.

Example: You pay a $20 copayment for each visit to your primary care doctor.

Out-of-Pocket Maximum
The most you will pay for covered services in a year.

Example: Once you reach your out-of-pocket maximum of $5,000, your insurance pays 100% of covered services.

Network Provider
A doctor or hospital that has a contract with your insurance company.

Example: Using a network provider usually costs less than going out-of-network.

Exclusion
A service or condition that is not covered by your insurance policy.

Example: Cosmetic surgery is often an exclusion in many health insurance plans.

Related Topics

Medicare
A federal health insurance program for people aged 65 and older, and some younger individuals with disabilities.
intermediate
Medicaid
A state and federal program that provides health coverage to low-income individuals and families.
intermediate
Affordable Care Act
A comprehensive healthcare reform law aimed at increasing health insurance coverage and reducing costs.
advanced

Key Concepts

PremiumsDeductiblesCopaymentsNetwork Providers