Workers’ Health Insurance Info

Health insurance –it pays for medical expenses. This is the general description. Sometimes it would include insurance for disability, long-term nursing or custodial care needs.

Souces: government-sponsored social insurance program, or from private insurance companies.

How: either on a group basis, or individually,

Purpose: to help protect selves from high or unexpected healthcare expenses.

Social welfare programs may be funded by the government.

Social health insurance (SHI) is a method for financing health care costs through a social insurance program based on the collection of funds contributed by individuals, employers, and sometimes government subsidies. It is one of the five main ways that health care systems are funded.  SHI systems are characterized by the presence of sickness funds which usually receive a proportional contribution of their members’ wages. With this insurance contributions these funds pay medical costs of their members, to the extent that the services are included in the, sometimes nationally defined, benefit package. Affiliation to such funds is usually based on professional, geographic, religious/political and/or non-partisan criteria.

Recession has workers and employers putting asides their differences to try and give in to each others wants and needs. The cooperation we see is awe inspiring for rarely do these two camps side on and decide as one on matters that may dictate the work they do and when they should do it. The worsening economic conditions are getting people fired faster that they can be created by the new government and the end isn’t even in sight.
Workers groups and management of the world’s top firms have had to compromise on steps they could take to maintain the integrity of the firms they work for or else risk going bankrupt ending up as a loss for all. Shortened work schedules, longer weekends and other compromise agreements are keeping workers in their jobs but the question is for how long. Management wants to keep their skilled people on-board as long as possible but time is against their side fro slumping sales cannot bring in enough cash to put back in the business to keep it running. Those who have ample health and employee insurance have a little more to offer but others without the said benefits want to keep their jobs so they can continue to bring home the bacon so to speak.

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Life insurance is often considered the all-important insurance more especially when children are still young. Bread winners want to be sure that if worse comes to worst, the family still has somewhere to stay, the house can still be paid and the children can still go to college. But they usually don’t remember the second worst thing – a disability that could leave the entire family with a depleted savings account or totally without income. In the USA, more life insurance than disability policies are being sold everyday when anyone who relies on income to support a family will definitely need it. The early death of a bread winner has a hard impact on the family, but disability can be equally hard to a family’s financial condition because together with the loss of income, other unforeseen expenditures will have to be incurred like rehabilitation, training for a new job, changes to the home or car to adapt to a handicap or 24-hour medical care.

Health Savings Accounts (HSA) is a special type of savings account that allows you to deposit part of your pre-tax income and use it in the future for medical, long term care, and/or retirement expenses. You can only get an HSA if you also have qualified high-deductible health coverage. The deductible must be at least $1050/year for individuals, or $2100 for families. They are designed to reduce healthcare insurance costs for employers and employees. HSA savings are owned by the individual, you keep the accounts no matter where – or if – you work. They also roll over from year to year, so you can accumulate savings over time. Some HSAs accumulate interest and dividends that are tax-free or tax-deferred. The money in these accounts can be used towards all kinds of medical expenses, including those not covered by your high-deductible health plan, such as dental care or over-the-counter medication.

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Disability cover is often passed by when looking for insurance. Although people will insure their estate and vehicles, they easily overlook the importance of insuring themselves personally against injury. Disability insurance pays funds when you can’t provide for your family.

Why do so many people over look this type of insurance?

While there is no way to know, it is often thought that people have the idea that they will not get hurt and they will be able to work as long as they would like. Unfortunately, that does not happen for many people.

People become ill or are involved in accidents without any warning, which could devastate a family that is dependent on their family for financial stability.

Disability insurance is often purchased as part of life insurance coverage, but can be sold separately. This is often called total and permanent disability insurance. It provides you with funds to pay for your bills should you be unable to work.

There are also some disability insurance plans that provide for temporary coverage, but this may also be provided by your health provider or your worker’s compensation (should you be hurt on the job). This type of temporary coverage is called income protection insurance.

From Wikipedia:

Premium: The amount the policy-holder pays to the health plan each month to purchase health coverage.

Deductible: The amount that the policy-holder must pay out-of-pocket before the health plan pays its share. For example, a policy-holder might have to pay a $500 deductible per year, before any of their health care is covered by the health plan. It may take several doctor’s visits or prescription refills before the policy-holder reaches the deductible and the health plan starts to pay for care.

Copayment: The amount that the policy-holder must pay out of pocket before the health plan pays for a particular visit or service. For example, a policy-holder might pay a $45 copayment for a doctor’s visit, or to obtain a prescription. A copayment must be paid each time a particular service is obtained.

Coinsurance: Instead of paying a fixed amount up front (a copayment), the policy-holder must pay a percentage of the total cost. For example, the member might have to pay 20% of the cost of a surgery, while the health plan pays the other 80%. Because there is no upper limit on coinsurance, the policy-holder can end up owing very little, or a significant amount, depending on the actual costs of the services they obtain.

Historically, HMOs tended to use the term “health plan”, while commercial insurance companies used the term “health insurance”. A health plan can also refer to a subscription-based medical care arrangement offered through health maintenance organization, HMO, PPO, or POS plan. These plans are similar to pre-paid dental, pre-paid legal, and pre-paid vision plans. Pre-paid health plans typically pay for a fixed number of services (for instance, $300 in preventive care, a certain number of days of hospice care or care in a skilled nursing facility, a fixed number of home health visits, a fixed number of spinal manipulation charges, etc.) The services offered are usually at the discretion of a utilization review nurse who is often contracted through the managed care entity providing the subscription health plan. This determination may be made either prior to or after hospital admission (concurrent utilization review). 

Exclusions: Not all services are covered. The policy-holder is generally expected to pay the full cost of non-covered services out of their own pocket.

Coverage limits: Some health plans only pay for health care up to a certain dollar amount. The policy-holder may be expected to pay any charges in excess of the health plan’s maximum payment for a specific service. In addition, some plans have annual or lifetime coverage maximums. In these cases, the health plan will stop payment when they reach the benefit maximum, and the policy-holder must pay all remaining costs.

Out-of-pocket maximums: Similar to coverage limits, except that in this case, the member’s payment obligation ends when they reach the out-of-pocket maximum, and the health plan pays all further covered costs. Out-of-pocket maximums can be limited to a specific benefit category (such as prescription drugs) or can apply to all coverage provided during a specific benefit year.