Introduction

Health insurance is one of the most important investments we make. If an illness, injury, or
other medical problem requires hospitalization, surgery, or other serious procedures, the costs
can be astronomical. maintaining health insurance;

The only way to get into the commercial medical business is to avoid getting stuck with out-of-
pocket costs for these emergency medical expenses.
Commercial Health Insurance
Private companies or nongovernmental organizations issue commercial health insurance.
Government-sponsored health insurance policies generally are reserved for specific groups,
such as senior citizens, people with low incomes, disabled people, current military members
and their families, veterans, and members of federally recognized Native-American tribes.
Examples of government-sponsored insurance include the Indian Health Service (IHS),
Medicare, Medicaid, the State Children’s Health Insurance Program (SCHIP), TRICARE,
and the Veterans Health.

The main types of health insurance plans are:

 Health maintenance organization (HMO)
 Preferred provider organization (PPO)
 Point-of-service (POS)
 Exclusive provider organization (EPO

Health Maintenance Organization (HMO)

An HMO allows you to get healthcare services from an approved network of providers.
Out-of-network care typically isn’t covered unless it’s an emergency.
You may be required to live or work in the HMO’s service area to get covered. You’ll
typically need to choose a primary care provider (PCP), and referrals may be necessary to see
a specialist.1
Preferred Provider Organization (PPO)
PPO plans allow you to visit out-of-network providers, but you save the most when staying
in network. You don’t have to choose a primary care provider and may not need a referral to
see a specialist if you’re going out of network.

Point-of-Service (POS)
A POS plan shares some features of an HMO and a PPO. You can choose a primary care
provider from the plan’s network. But you can also go out of network to seek care, either by
choice or out of necessity. You may also need to choose a primary care provider and get
referrals for care.

Exclusive Provider Organization (EPO)

An EPO is a type of managed care plan similar to HMO and PPO plans in certain regards.
You’re only covered when you see in-network providers. However, you don’t have to
choose a primary care provider, and you don’t need a referral

How Much Insurance Does Someone Need?

Each person is different and not everyone needs the same amount of insurance. The limiting
factor for many people is the cost of the plan. But a person should make sure to get the most
coverage for the money he or she spends.

Whether choosing insurance for the first time or evaluating a current plan here are some
things to keep in mind:
 Affordability. Compare monthly premiums, deductibles, co-pays and/or co-
insurance to make sure you are getting the best deal for your health insurance needs.
Consider not just about how much you pay per month, but also how much money is
needed to pay co-pays and co-insurance.
 Availability of mental health professionals. Make sure there is a broad range of
mental health professionals included in the health plan’s network of providers. Some
mental health professionals do not take insurance, so check to see what the insurance
 plan will pay for out of network providers.
 Coverage of prescription medications. If a person has found the right medication to
treat their illness, she should find a plan that covers that medication to maintain
wellness.
 Limits on the number of mental health-related office visits. Some health plans
place limits on the number of office visits for things like therapy. Choose a plan that
allows the number of visits needed. Depending on a person's need, he may need to
consider differences in inpatient and outpatient coverage.
The common most used when health services are denied:

Medical necessity criteria are standards used by health plans to decide whether
treatments or health care supplies recommended by your mental health provider are
reasonable, necessary and appropriate.

Utilization review, also known as utilization management, is the process used by
insurers to decide whether the requested mental health care is medically necessary,
efficient and in line with accepted medical practice.

Prior authorization, also known as pre-approval, preauthorization, prior approval
or precertification, is a type of utilization review. It is when you or your service
provider must ask for approval before your health plan will agree to pay for a service,
treatment plan or prescription drug.

Step therapy is a type of prior authorization in which you must try a less expensive
prescription drug or service before you can move to a more expensive prescription or
service.
Benefits of having a Health insurance Policy

1. Cashless Treatment: If you are insured, you can get cashless treatments as your
insurance company would work in collaboration with various hospital networks.

2. Pre and post hospitalization cost coverage: Insurance policy also covers pre and
post hospitalization charges up to the period of 60 days, depending on the insurance
plans purchased.
 3. Transportation Charges: Insurance policy also covers the amount paid to
ambulance towards the transportation of insured.

4. No Claim Bonus (NCB): This is the bonus element which is paid to the insured if
the insured does not file a claim for any treatment in the previous year.

5. Medical Checkup: Insurance policy also provide options for health checkups. Free
health checkup is also provided by some insurers based on your previous NCBs.
Types of Health Insurance

Individual Health Insurance


Family Health Insurance Plan

Surgery and Critical Illness Insurance Plan

Maternity Health Insurance Plan

Senior Citizen Health insurance Plan
Importance of Health Insurance
Buying a health insurance policy for yourself and your family is important because medical
care is expensive, especially in the private sector. Hospitalisation can burn a hole in your
pocket and derail your finances. It will become even tough, if the person who brings in the
premium which would lessen your stress in case of medical emergencies. A good health
insurance policy would usually cover expenses made towards doctor consultation fees, costs
towards medical tests, ambulance charges, hospitalization costs and even post-hospitalization
recovery costs to a certain extent

REFRENCE

https://www.investopedia.com/types-of-health-insurance-

https://www.nami.org/Your-Journey/Individuals-with-Mental-Illness/Under
standing-Health-Insurance

https://cleartax.in/s/health-insurance