A healthy body is a happy body, and there’s no better way to preserve your health and your family’s health than with a health insurance policy from Village Insurance.
Let’s face it, medical treatments aren’t cheap. Without health insurance coverage you could end up paying off medical bills for the rest of your life. Village Insurance can help you find an affordable healthcare plan that’s right for you. Contact one of our friendly agents today to learn more.
Types of Health Insurance in Texas
There are basically three major types of Texas health insurance policies to choose from: consumer-directed, fee for service, and managed care. These health insurance plans help cover your medical, surgical, and hospital expenses. They may even cover dental expenses, mental health services, and prescription drugs, depending on the coverage you choose.
A consumer-directed health plan (a.k.a. “consumer-driven” or “consumer choice”) is a newer type of healthcare plan that’s designed to give you more control. As part of the plan, you setup a health fund that can be used to cover medical expenses.
- Fee for Service
A fee for service plan is a more traditional healthcare plan. It means you pay a fee to your provider for every healthcare service you receive. The benefit of this type of health insurance plan is that it allows for a lot of flexibility when choosing a physician or healthcare provider.
- Managed Care
Members of managed care health plans generally enjoy more benefits like lower out-of-pocket costs. However, you can only receive treatment from physicians that participate in the managed care network. Typical managed care plans include health maintenance organizations (HMOs), preferred provider organizations (PPO), and point-of service (POS) plans.
Common Health Insurance Terms
When discussing health insurance with an agent, it helps to understand some of the common terms you’ll hear. Below you’ll find definitions to some of the most common health insurance terms.
- Deductible - The amount of money you pay toward medical bills before your insurance coverage begins.
- Co-pay - A specified amount of money you pay upfront for doctor visits and prescription refills.
- Coinsurance - The percentage of medical bills you pay after meeting the deductible.
To learn more about Texas health insurance, call and talk with one of our agents today. We’ll guide you toward a more secure future.
Health Insurance Key Terms
- Premium - The amount the policy-holder or his sponsor (e.g. an employer) pays to the health plan to purchase health coverage.
- Deductible - The amount that the insured must pay out-of-pocket before the health insurer pays its share. For example, policy-holders might have to pay a $500 deductible per year, before any of their health care is covered by the health insurer. It may take several doctor's visits or prescription refills before the insured person reaches the deductible and the insurance company starts to pay for care.
- Co-payment - The amount that the insured person must pay out of pocket before the health insurer pays for a particular visit or service. For example, an insured person might pay a $45 co-payment for a doctor's visit, or to obtain a prescription. A co-payment must be paid each time a particular service is obtained.
- Coinsurance - Instead of, or in addition to, paying a fixed amount up front (a co-payment), the co-insurance is a percentage of the total cost that insured person may also pay. For example, the member might have to pay 20% of the cost of a surgery over and above a co-payment, while the insurance company pays the other 80%. If there is an upper limit on coinsurance, the policy-holder could end up owing very little, or a great deal, depending on the actual costs of the services they obtain.
- Exclusions - Not all services are covered. The insured are generally expected to pay the full cost of non-covered services out of their own pockets.
- Coverage limits - Some health insurance policies only pay for health care up to a certain dollar amount. The insured person may be expected to pay any charges in excess of the health plan's maximum payment for a specific service. In addition, some insurance company schemes have annual or lifetime coverage maximums. In these cases, the health plan will stop payment when they reach the benefit maximum, and the policy-holder must pay all remaining costs.
- Out-of-pocket maximums - Similar to coverage limits, except that in this case, the insured person's payment obligation ends when they reach the out-of-pocket maximum, and health insurance pays all further covered costs. Out-of-pocket maximums can be limited to a specific benefit category (such as prescription drugs) or can apply to all coverage provided during a specific benefit year.
- In-Network Provider - (U.S. term) A health care provider on a list of providers preselected by the insurer. The insurer will offer discounted coinsurance or co-payments, or additional benefits, to a plan member to see an in-network provider. Generally, providers in network are providers who have a contract with the insurer to accept rates further discounted from the "usual and customary" charges the insurer pays to out-of-network providers.
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