Health insurance is a health insurance risk hedged against the probability that if and when someone unexpectedly becomes sick, requires expensive treatments, or is at the mercy of a chronic condition that requires long-term care they will not fall into dire financial straits.
Who will pay for all of the medical expenses?™
High-quality health care affects health and wellness. A health insurance policy is a contract between an insurance company and a policy holder intended to safeguard against high and unexpected health care costs. Although policy-holders pay a monthly premium, co-payments, co-insurance, and deductibles, it is expected that the total is far less than that required if paid fully out-of-pocket.
Health insurance is a benefit provided through a government agency, private business, or non-profit organization. To determine cost, a provider estimates collective medical expenses of a population, then divides that risk amongst the group of policy subscribers. In concept, insurers recognize that one person may incur large unexpected expenses, while another may incur none. The expense, then, is spread among a group of individuals to make health care more affordable for the common good of all. In addition, public health programs like Medicare, Medicaid, and SCHIP are federally-funded and state-run to provide additional medical coverage to those in vulnerable groups who qualify, such as seniors and those with disability.
An individual with Cerebral Palsy will likely require specialized medical services throughout his or her lifetime. The expense for a chronic disability can greatly exceed the expense for standard care an individual without the condition incurs. Cerebral Palsy results in a chronic, physical impairment, which typically involves routine doctor visits, extended hospital stays, a range of therapies, planned surgeries, drug therapy, and adaptive equipment. Depending on the level of impairment, Cerebral Palsy usually requires a comprehensive, multidisciplinary health care team that may include any combination of the following: pediatrician, neurologist, radiologist, orthopedic surgeon, physical therapist, occupational therapist, and vocational therapist. Some individuals also require the assistance of a registered dietician, a speech pathologist, ophthalmologist, urologist, and a cosmetic dentist, amongst others.
Coverage from a health insurance policy or a public health program can greatly relieve the financial burden of health care expenses due to Cerebral Palsy. Those who are uninsured or underinsured can experience financial strain and require assistance from alternative funding sources such as community groups, charity organizations, or local business establishments. When no health insurance exists, providers often request payment in advance of services, or a payment plan agreement.
Health insurance offers long-term protection and contributes to a family’s physical, emotional and financial well-being.
Many choices must be made when choosing a health insurance option. Some recommended steps to follow during the selection process include:
- Review helpful health insurance terminology. Understanding health insurance lingo assists with understanding the benefits each plan truly delivers.
- Create a checklist of family health insurance needs. Make a list of health insurance coverage preferences you know your family will require. For example, should prevention or major medical coverage be the priority? Will dental, vision, and prescription coverage be necessary? Once complete, the checklist is used to evaluate and compare health insurance providers, plan choices, and coverage offered.
- Research available health insurance providers. Does a parent’s employer offer insurance plans? If so, when is enrollment and what are the options? Does the parent belong to any clubs, special interest groups, or organizations that offer health insurance? Are they eligible and approved for any government insurance plans? Do they want to pursue an independent provider?
- Decide between an indemnity plan or a managed care plan. If considering a managed care plan, determine which type of coverage best suits the family’s needs–indemnity, HMO, PPO or POS.
- Request a quote for one or two appealing plan options.
- Review policy provisions against checklist of family health insurance needs.
- Decide whether the quote is within the family’s financial means.
- Apply for the plan of choice.
To better understand health insurance, the following are terms common when analyzing policy provisions:
- Pre-existing conditions – a health condition that exists prior to health insurance coverage.
- Pre-existing condition exclusionary period – a period of time established by the health insurance provider in which pre-existing conditions are not covered by the health insurance plan.
- Pre-screening – a screen performed in advance of health insurance coverage to determine if a condition exists.
- Insurance policy – a contract between the insurance provider and a policy holder intended to safeguard against high and unexpected health care costs.
- Explanation of benefits – a document that explains the nuisances of the health insurance coverage to be provided under the plan contract. It describes what is covered, and what is not covered, and details the policies and procedures required of the insurer and insured for health insurance administration.
- Major medical – health care for the purpose of curing or treating a disease, injury, or illness. Some policies focus on major medical coverage, while others concentrate on preventative care.
- Preventative care – health care for the purpose of preventing disease, injury, or illness. Some policies specialize in preventive coverage, while others concentrate on major medical.
- Dental coverage – coverage for basic preventative and routine dental procedures. Some policies have higher premiums if dental coverage is desired. Some policies no longer provide dental coverage.
- Prescription coverage – coverage for medication and drug therapy expense. Some policies have higher premiums if prescription coverage is desired. Some policies no longer cover prescriptions.
- Exclusions – expenses or services not covered under the insurance plan.
- Coverage limits – a maximum amount that the health insurer agrees to pay for a particular health care service. Some policies have annual limits and lifetime coverage limits.
- Out-of-pocket maximums – a maximum amount that an insured pays before all other covered expenses are paid by the health insurer.
- Co-insurance – an established percentage, above and beyond the co-pay, which is required of the insured to pay per procedure.
- Premiums – the amount the policy holder and the insured periodically pay into the health plan for health care coverage.
- Co-pay – an amount the insured is required to pay per procedure before the health insurer pays the remaining balance. Plans with co-pays can be more affordable than those with lower co-pays or no co-pay.
- Deductible – an established amount the insured is required to pay out-of-pocket before the health care expense is covered by the health insurer.
- In-network and out-of-network providers – some plans cover different costs from in-network, versus out-of-network, providers. In-network providers are those who agree to the health insurer’s policies and procedures and typically result in less expense to the insured. Out-of-network providers are those providers that have not yet agreed fully to the health insurer’s policies and procedures. The insurer typically cover less expense or no expense at all for out-of-network providers.
- Prior authorization – some health insurance plans require services to be pre-approved by the insurer prior to actually incurring the expense. If not approved, the insured runs the risk of having the expense denied by the plan. Emergency services and minor preventative procedures are often not required to be pre-approved.
- Riders – amendments that permanently exclude services to a specific condition.
Finding affordable health insurance for children and adults with long-term medical conditions, such as Cerebral Palsy, can be a major concern for most parents. A health insurance policy is a contract between an insurance company and a policy holder intended to safeguard against high and unexpected health care costs.