Social insurance definition is protection of the individual against economic hazards such as unemployment, old age, or disability in which the government participates or enforces the participation of employers and affected individuals. Yet every day, its becoming more and more important for health care consumers to have at least a. The relative level of health spending in the region was very low, with a few exceptions in countries where spending was a little more than 6% of their gdp on health. Webmd provides definitions of terms related to health insurance, the affordable care act and medicare. When making decisions about health coverage, consumers should know the specific meanings of terms used to.
When reading the definitions, please keep in mind that this glossary is provided as a guide only curated from various sources. The specific coverage offered by a health insurance policy. Health insurance is an insurance that covers the whole or a part of the risk of a person incurring. The health insurance marketplace, or health insurance exchange, is a federal government website where you can shop, compare and buy plans offered by participating health insurance companies in your area. Insurance is appropriate if the loss will cause you or your loved ones a significant financial loss or inconvenience. Social health insurance is an insurance program that meets at least one of the following three conditions.
Health insurance policies are categorized as privately paid for by an individual, publicly provided as a service through social security, or commercially arranged by a company as part of an employee benefit package. Health insurance is one of the ways that people in various countries finance their medical needs. Broader levels of health insurance coverage generally have higher premium costs. Archived from the original pdf on 17 december 2008. Private health insurance is usually financed on a group basis, but most plans also provide for individual policies. Good health insurance coverage can mean that a company covers expensive medical treatments. These general definitions are provided for educational purposes. Obamacare health insurance plans for individuals and families. Health insurance also referred to as medical insurance or health care insurance refers to insurance that covers the cost of a policyholders medical expenses. What is social health insurance meaning and definition. Browse our glossary for more health insurance definitions, and get more information on how your costs work together. Social insurance definition of social insurance by merriam. These health insurance terminologies will give you a better understanding of health.
A health insurance policy like other policies is a contract between an insurer and an individual group in which the insurer agrees to provide specified health insurance cover at a particular premium subject to terms and conditions specified in the policy. Health insurance benefits financial definition of health. Claims, premiums, deductibles copayments and coinsurance. However, with such a range of types of coverage, as well as the complicated nature of the insurance. These glossary terms and definitionsare intended to be educational and may be different from the terms and definitions in your plan or health insurance policy. Major medical health insurance will protect you from uninsured tax penalties. Which particular health insurance plan a consumer chooses depends on. Insured is increased by a certain percentage at the time of. According to the institute of medicine1,2 policy development is an essential public health function.
Below are definitions for some of the more commonly used terms and how. In short, the exercise of market power adversely affects health insurance coverage and health care. On march 23, 2010, president obama signed the patient protection and affordable care act ppaca into law. Pdf this chapter examines the characteristics of insurance contracts. Small businesses can use the small business health options program shop marketplace to provide health insurance for their employees. A plan that covers or shares the expenses associated with health care. Do keep in mind that in some instances, you are required to purchase insurance i. Below are definitions for some of the more commonly used terms and how ppaca impacts their use. Health insurance definition of health insurance by merriam. That is why choosing a health insurance plan that is right for you, and understanding how it works, may seem confusing. How much the insurance covers and how much the policyholder pays depends on the type of insurance. It is a form of risk management, primarily used to hedge against the risk of a contingent or uncertain loss an entity which provides insurance is known as an insurer, insurance company, insurance carrier or underwriter.
Health insurance definition of health insurance at. Classification, types, life insurance policy scope terms and conditions, best policy. The insurance handbook reflects this diversity of subjects and issues. Filing health insurance claims sorting out health insurance coverage most people are confused about their health insurance coverage in that they are never really certain as to what they are entitled to collect. The doctors, hospitals, and suppliers your health insurer has contracted with to deliver health care services to their members. Glossary of health care terms health insurance illinois. For the most part insurance policies are difficult to read and understand. An insurance plan thats certified by the health insurance marketplace, provides essential health benefits, follows established limits on costsharing like deductibles, copayments, and outofpocket maximum amounts, and meets other requirements under the affordable care act. For example, health insurance benefits may pay for most or all of the costs of a surgery. Applying this to health insurance, in theory, a household can afford to pay for health insurance if it would have enough income left to meet its other sociallydefined minimum needs, such as food and shelter. How to understand your costs and key health insurance. The amount you pay for your health insurance or plan each month. Barefoot doctors in agricultural communes and workplace clinics provided primary care. These glossary terms and definitionsare intended to be educational and may be different from the terms and definitions in your plan.
These three terms are often used interchangeably, leaving the definition of private health. A first step in assessing the existence of or the potential for market power is to examine market concentration, as high concentration tends to lower competition. It also has a precise definition under the health insurance portability and accountability act of 1996 that exempts from certain requirements insurers that sell insurance to small employers only through association health plans that meet the definition. Health care was provided through public facilities at three levels. Health insurance is an insurance product which covers medical and surgical expenses of an insured individual.
Glossary of health coverage and medical terms this glossary defines many commonly used terms, butisnt a full list. Pdf health insurance is one of the ways that people in various countries finance their medical needs. All health insurance plans compliant with the affordable care act the law commonly referred to as obamacare are major medical health insurance plan. In health insurance, all types of medical expense coverages are contracts of. Private health insurance is usually financed on a group basis, but.
Please refer to your policy or certificate of insurance for exact definitions of terms and coverage provisions. Mar 26, 2020 social insurance definition is protection of the individual against economic hazards such as unemployment, old age, or disability in which the government participates or enforces the participation of employers and affected individuals. The health insurance marketplace also known as the marketplace or exchange provides health plan shopping and enrollment services through websites, call centers, and inperson help. Its okwe know as well as anyone that the language of health insurance can be hard to understand. When making decisions about health coverage, consumers should know the specific meanings of terms used to discuss health insurance. Coinsurance a form of medical cost sharing in a health insurance plan that requires an insured person to pay a. Health insurance is an insurance that covers the whole or a part of the risk of a person incurring medical expenses, spreading the risk over numerous persons. However, with such a range of types of coverage, as. Insurance handbook insurance information institute. It reimburses the expenses incurred due to illness or injury or pays the care provider of the insured individual directly. Insurance is a means of protection from financial loss. There are both private and public health insurance plans, with different plans offering different benefits. Insurance is an intricate product and so is its glossary.
No background in health insurance is assumed, and all terms are defined in the body of the report. Some people may qualify for governmentfunded health insurance, such as medicare or medicaid, if they meet certain eligibility requirements. Health insurance glossary health insurance definitions and. Insurance system gis was established in 1952 for government staff and retired government staff, and university students.
Why is it important to know about health insurance. Health insurance is a health financing mechanism that involves both prepayment and. Health insurance glossary insurance compare insurance. Health insurance is a type of insurance coverage that pays for medical and surgical expenses incurred by the insured. Peoples republic of china, the china health insurance association, and the. Different types of major medical health insurance include. Insurance pdf types of insurance, scope of insurance. They also may cover doctors visits, medical procedures, prescription drugs, and so forth. Getting to know and understand the terms can go a long way to help you understand the plan and thus choosing the best one. The percent for example, 40% you pay of the allowed amount for covered health care services to providers who do not contract with your health insurance or plan. A health insurance system that is organized and administered by an insurance company or other private agency, with the provisions specified in a contract, is known as private, or voluntary, health insurance. What a health insurance policy would normally cover. By estimating the overall risk of health care and health system expenses over the risk pool, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to provide the money to pay for the health care.
Some of these terms also might not have exactly the same meaning when. It is estimated that outofpocket expenditure of over 1520 % of total health expenditure or 40. A consumer may find the purchase of health care inherently different from some other purchases. However, public health goals can also be achieved working in other sectors like education, agriculture, or employment, among others. Common health insurance terms and definitions wps health. Here we have listed and defined a few common terms used in health insurance.