There are many different kinds of health insurance benefits and these are defined specifically by each health care plan. Due to these differences, checking the terms of each plan is wise. Fine distinctions between one plan and another can inform choice, if choice is available. However, most people might expect to see some basic types of coverage such as preventative health coverage, coverage for common illnesses, and some assurance of care if illness is severe and requires hospitalization or surgery.
While each different type of health plan may offer these types of coverage, not all of them do so at the same payment rate or allow unlimited use without exclusions. For instance, getting health insurance with an HMO (health maintenance organization) might mean people pay a copayment when they see doctors for permitted preventative care or care when they’re ill. Those with HMOs can also expect that their benefits will be limited to doctors and providers that belong to the HMO. Other times health insurance benefits might mean people get a percentage of coverage when they seek health care, usually 80%, and they may have a deductible they must meet first before any care is offered.
States or federal governments may require certain health insurance benefits in areas of preventative care or aftercare. For example, a number of states require that health insurance pay for women to stay in the hospital, up to the limits of their plan, for 24 hours after giving birth. In the US, as of 2010, if a health plan offers mental health services, it must offer these on parity with regular health care services, and most mental illnesses with a biological basis are covered under this requirement. In many states one of the benefits of having plans where people must choose a primary care physician is that states insist patients have choice in their doctor who could be a general practitioner, internist or gynecologist.
Usually, health plan companies provide at least minimum standards of health insurance benefits and preventative care as suggested by doctors. Types of care could include well child checks up to a certain age, yearly exams, and certain tests like mammograms, and companies almost always provide care when people are sick or injured. Some health insurance benefits don’t function this way, however. People may purchase catastrophic health insurance which doesn’t cover any of these things and only begins to provide coverage after high deductibles are met, and in cases of extreme illness or debilitation.
Other forms of health insurance benefits may come in a single plan or might be met by purchasing other plans. Many people have to maintain dental insurance separately from their health insurance. People who want vision care may need to pay for this separately too. Fortunately, when people can get these adjunct plans through a company, they’re usually low-priced.
It should be clear that very few health insurance benefits are complete. They normally require copays, coinsurance or deductibles and they will place limits on care as much as they are allowed to by the state in which they are operate. Some plans have very generous benefits, allowing doctors to decide what is best needed for their patients, and more often, others strictly regulate costs and determine exactly what they will provide. Plans may also be unwilling to make payment unless the member has done everything in the necessary order. For example, failing to get approval prior to hospitalization that is not an emergency might mean voiding the terms of the insurance and receiving no benefits for it.