Explanation of Health Insurance Benefits

May 30, 2013

Health care and health insurance have been frequent and even historic headline news features, especially during the Obama administration. The health care debate has become a key point of contention at the federal government level, and filters down to states, localities, and individual families. One of the primary issues focuses on the lack of affordable health care and adequate health insurance options for far too many Americans, especially those who don’t have employer-provided health care plans.

Difficulties of No Health Insurance

Those individuals who don’t have health or medical insurance typically face difficult decisions. No insurance sometimes means people must choose between receiving routine or necessary medical attention, and accruing the related expenses and debt – or not receiving heath care services and facing the consequences. Other indviduals sometimes choose between spending money on essential precription medicine – or food and household necessities, and paying bills like mortgage or rent, electricity, and other utilities.

Even routine health care is expensive without health insurance, while emergency or catastrophic care can wipe out an individual’s or family’s life savings and initiate lifelong indebtedness. Affordable health or medical insurance is a necessity for individuals who don’t have access to any kind of health plan through their employers. Numerous health insurance benefits are available, depending on the company’s plan, which varies in covered and non-covered conditions, deductibles, co-payments, and other details.

Health Insurance Benefits

Various insurance companies offer either specific medical insurance plans or compile quotes from a range of health insurance companies to allow consumers to compare costs and benefits among many companies. Several of the most well-known health insurance companies include the following: Aetna, Anthem Blue Cross and Blue Shield, Health Net, and Kaiser Permanente. It is important for an individual to carefully evaluate health plans to determine which one best suits his or her needs, with the most desirable health insurance benefits.

Health care insurance companies differentiate between basic benefits and comprehensive benefits, with the appropriate range of deductibles, co-payments, rates, and premiums. The term “benefits” typically refers to the illnesses and conditions covered and services offered under a specific health care plan. Benefits may only cover medical care, or may include vision, dental service as well. Other benefits may cover injuries sustained during different types of accidents.

Basic health or medical insurance benefits usually cover preventative or routine care. For instance, basic covered medical care benefits usually include routine check-ups, well baby care, maternity care, and prescription drug coverage. If plans include dental and/or vision benefits, these usually cover annual appointments for such things as tooth cleanings and exams, and eye exams. Some dental plans may include partial coverage for services such as fillings and extractions.

Comprehensive benefits encompass basic benefits along with coverage for more serious illnesses, conditions, or injuries. For example, comprehensive health care plans may cover some portion of expenses related to emergency care, accidental injuries, necessary surgeries, or referrals to specialists for essential procedures.

Depending on the insurance company, individuals may be able to obtain benefits for various types of cancer care and specialized care for other terminal illnesses.

Other benefits may cover mental health services or special services for children, such as speech and developmental therapy.

Some medical insurance plans may contain “riders” which are terms to provide partial benefits or discounts for other types of care. This could include care and services provided by specialists, nutritionists, chiropractors, and dermatologists, among others.

Anyone in need of health insurance coverage should assess their needs and their budgets, along with the desired benefits. After that, an individual should compare various health care plans to determine which one best suits his or her needs.

Post author Loren Pleet