Health Insurance plans vary but dependant on the scope of coverage offered health insurance plans most often pay for part or all of the cost of the following types of services:
Basic services like visits to the a doctor's office; surgery; hospital care; physical therapy; mental health and substance abuse treatment.
Prescription drugs.
Preventive and diagnostic services such as physical exams; immunizations; annual gynecological (well-woman) exams; cancer screening (Pap tests, mammogram's, prostate exams etc); x-rays; laboratory tests and if needed second opinions for surgery.
Wellness programs, for example to help you stop smoking; weight-loss programs; stress-control courses; discounts at fitness facilities; health-related information via the Internet.
Emergency care. Generally speaking, your situation is an emergency if you expect the following to happen if you do not seek care:
You would jeopardize your health or your child's health.
If you were pregnant, the health of your unborn child would be in jeopardy.
You would have serious impairment of bodily functions.
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Even the most comprehensive health insurance plan would not cover certain kinds of services. Every health insurance plan includes a list of items not covered by the health insurance plan and these will be listed as "health insurance plan exclusions"
These typically are:
Cosmetic procedures and surgery except repair to damage caused by an injury or illness.
Custodial or long term care.
Treatment considered experimental.
Hearing aids.
Over-the-counter drugs (such as aspirin).
Health Insurance preferred provider organizationsA preferred health insurance provider organization (or PPO ) is a managed care organization of medical doctors, hospitals, and other health care providers who have covenanted with a health insurer or a third-party administrator to provide reduced rates to the insurer s or administrator s health insurance clients.
Preferred health insurance provider organization will provide the insured members of the group a substantial discount below their normal rates. This is mutually beneficial as the health insurance insurer is billed at the reduced rate when its insured use the services of the prefe ..
Procedures that aren't medically necessary.
Work-related injuries or illnesses as these would normally be covered under workers' compensation coverage).
Once you have selected a health insurance plan and signed a contract, the insurer is obliged to provide a legal document called the Evidence of Coverage (EOC) that describes the benefits covered and your rights under the plan. It is important that you read this document and refer to it often, this will help in your understanding of the health insurance plan benefits.
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