June 03, 2019


Introduction: This article comprises whole lot of topics and subtopics for your understanding and answers to your questions, we shall be talking about health insurance as the keyword because every topic we shall be discussing here should involve around health insurance. Health insurance is one of the most important insurance politics as it involves the healthy life of a person. It’s been said “that health is wealth”, the ability of a man to live a healthy daily life is the beginning of success and more advancement to it. 

Well quickly let’s typically buttress on the course of our topic which is health insurance plans for individual and low income adult but first

What is health: health is the ability of a person to live either at a good or bad state of body system and which affects the daily living of such person presently or grow within a specific time. In other words we are saying health can be in a good(positive) or bad(negative) state and when in a good state it is been said such person is living on illness free life and if in a bad state is been known that such person is facing one illness or the other which causes discomfort. 

The ability to live a healthy life is affected by so many factors which can include dirty environment, the type of food you eat, un cleanliness and so many others , but some of these illness are self caused and by others can be natural that just come unexpectedly once in  awhile but many fear the state of been ill because it causes great discomfort and hinders daily activities and the greatest fear is when  you fall into such state (bill) and unable to take care of yourself due to lack of finance or low income which you could make you not to be able to take care of yourself immediately . You could be financially buoyant today and tomorrow is no longer coming a expected, in this case what do you? Do you start taking up loan to afford taking care of huge health cost due to this lapses it came about the need for insuring your health which is called “health Insurance

What is health insurance? Health insurance can be defined as that type of insurance that covers the whole or part of the risk of a person incurring medical expenses and spreading the risk over a large number of persons. Health insurance coverage pays for the benefit as a result sickness or injuries. It includes insurance for losses from accident, disability, medical expenses or accidental death. A contact that requires a health insurer to pay some or all of your care cost in exchange for a premium, the health insurer is the insurance company that sells insurance plans/policy in which special benefits ar allocated to the insured(the person who buys the policy) which are covered by your health insurance policy through the purchase of premium(money paid to the insurance company) in order to receive the benefits that will be paid by the insurance company

How health insurance works:

Upon taking a health insurance plan, the date your policy begins will totally depend on when you apply for coverage, as you take up the policy, the insurance company will send you the plan/policy information including ID Cards to use when claiming your benefits like visiting the doctor’s office, pharmacy or hospital. Your health insurance company will send an explanation of benefits outlining the charge for your care, the portion your plan covers and the amount you will likely be charge-out-of-pocket expenses. Your insurer pays your provider (health institutes or organizations) their share, then you are been billed for the remaining balance which you pay directly to them

Types of health insurance

There are basically seven types of health insurance plans that I beneficial to you but having the right health insurance benefits for you or your business is very important. Knowing the types of this health insurance plan will help you evaluate the options each year as part of your internal small business audit or personal life. We shall briefly discuss the types of health insurance plan as it is not our major keyword or topic 

1 Preferred Provider organization (PPO): a PPO plan is a preferred provider organization group health insurance plan/policy. With this plan, employees are encouraged to use a network of preferred doctors and hospital/these providers are contracted to provide service to plan members at a negotiated or discounted rate.

2 Health Maintenance Organization (HMO): with this plan, employess generally has lower out-of-pocket expenses but also have less flexibility in the choice of physicians or hospitals than other plans. This plan may require employees to chose a primary care physician (PCP) , to see a specialist, employee will need to obtain a referral from their PCP. HMO’s generally provide coverage for a broader range of representative services than other policies. Employee may or may not be required to pay a deductible before their coverage starts and would usually have a co-payment.

3 Point of service plan (POS) : This plan combines features of HMO and PPO plan. POS also may require employees to choose primary care physician (PCP) from the plan’s network providers. In, general services rendered by the PCP aren’t subject to the policy deductible.

4 Exclusive providers Organization (EPO’s): This plan are similar to the HMO plan because they have a network of physicians that their members are required to use except in the case of emergency. Employee members will have a primary care physician (PCP) who will provide referrals to in-network specialist, EPO members are responsible for small co-payments and may require a deductible.

5 Indemnity Health Insurance Plan: this plan is known for fee-for-service plans because of cost paid to the members for covered services. The member may be responsible for deductibles and co-insurance amounts

6 Health savings accounts: this type of plan is tax favored savings account that is used in conjunction with an HAS-compatible high deductible health plan to pay for qualifying medical expense, though this plan can be attached to group health insurance

7 Qualifying small employer health reimbursement arrangements (QSEHRA): This plan is a small business health insurance benefit specifically designed for business with fewer than 50 employees, it also allows of tax free money for employees by small business. It is a good solution for small business because there is no minimum contribution requirements and all full time employees receives value.

Advantages and benefits of Health Insurance

Advantages and Benefits of Health Insurance includes the following categories:

Health Insurance is often ignored by young professionals and their attitude towards Health Insurance has been somewhat lax. A basic health insurance policy offers a wide range of benefits that protect individuals and low income earners from unexpected medical expenses. This policy will cover for medical treatment expenses, pre and post.

Hospitalization expenses, room rent, critical illness, domiciliary expenses and day-care procedure. Insurance companies offer some of the best term insurance plan based on your needs and requirements. Hence it will bring down medical expenses to a great extent so that your family does not feel the pressure of the situation.

1 Ambulatory patient service

2 Emergency services

3 Hospitalizations

4 Maternity and newborn care

5 Mental health and substance abuse disorder services (including behavioral health treatment)

6 Prescription drugs

7 Rehabilitative and habilitative services and devices

8 Laboratory services

9 Preventive and wellness services and chronic disease management

10 Pediatric services, including oral and vision care

In broader terms we can say the advantages and benefits include:

1 Cashless Treatment - If you are insured with health insurance the insurance company works in collaboration with the respective hospital.

2 Pre and post hospitalization cost coverage - Health insurance policy also covers pre and post hospitalization charges depending on the insurance plans purchased.

3 Transportation Charges - It covers the ambulance charges for the transportation of insured.

4 No Claim Bonus - This is offered in case policyholder does not file a claim for any treatment in the previous year.

5 Medical Checkup - Few insurance companies offer free health checkup option based on previous NCB’s

6 Room Rent - Depending on the premium amount being paid hospital room expenses are also covered for the policyholder.

7 Tax Benefit - Premium paid on Health insurance is tax deductible under section 80D of the Income Tax Act.

8 Alternative Treatment : Various health insurance companies in India offer alternative treatment benefits. Presently alternative treatment has gained considerable popularity. Many insurance providers offer alternative treatments such as Homeopathy, Yoga, Ayurveda, etc. under their health insurance plans.

9 Attendant Allowance : Health insurance companies now offer attendance allowances to the adults accompanying the insured person at hospital given that the insured is a child. However, the number of days for which an insurer provides attendant allowance is fixed.

10 Bariatric (Weight loss) Surgeries : Since bariatric surgeries are no longer considered as cosmetic weight loss process and are seen as a life-saving treatment for obese people who are suffering from weight related diseases, various health insurance companies offer Bariatric (Weight loss) Surgeries.

11 Convalescence Benefit : Convalescence benefit is also known as recuperating or recovery benefit. This takes care of the insured person’s recovery expenses. The convalescence benefit is offered in order to cover additional costs that could arise out of hospitalization, such as loss of income.

12 Daily Hospital Cash Allowance : Health insurance companies nowadays cover the expenses that are not covered under the mediclaim policy, such as travelling and food. Under daily hospital cash benefit, insurers offer a certain amount of money per day depending on the type of plan and insurance company you choose.

13 Domiciliary Treatment : Domiciliary treatment stands for the treatment at home under medical supervision. Many health insurance companies have now extended this coverage. However, the expenses arising out of domiciliary treatment has been capped down to a certain limit for a certain number of days.

14 Dental Treatment : A number of health insurers offer dental covers and takes care of the dental treatment once in a certain period of years.

15 Expenses Related to Organ Donor : Health insurance policy also covers the expenses related to organ donor as well. Given that the basic cost of a kidney transplant could range somewhere between Rs. 3 to 6 Lakhs, health insurance policy takes care of this. Some health insurance companies reimburse the entire cost of an organ donor while some impose a cap on the expenses and offer it as an add-on cover.

16 Free Health Checkup: You can avail free health checkup under your health insurance policy. Free health checkup is generally offered periodically once after every 4 claim free years.

Health Insurance for Individuals and Low Income Earners

Health Insurance plan for individuals

There are many insurance companies that offer attractive options on Individual Health plan. It is reasonable to get confused as to which Individual Health Insurance policy to purchase.

Here is how you can choose the best Health Insurance for individual:

1 Compare all the benefits and offers offered to you by the Health Insurance companies on the Internet.

2 Go for the insurance policy that offers you the highest sum insured on health and medical treatments.

3 Choose the health insurance plan that has the minimum waiting period on pre-existing illnesses. Most of the insurance companies have a waiting period of 2 to 3 years.

4 Purchase a Health insurance policy that has the maximum age limit for renewability of the policy. So that the policy you buy at younger age can insure you at old age after renewal.

5 Check the company’s claim settlement ratio. Go with the ones that have the highest claim settlement ratio.

6 Go for the insurance companies that offer the maximum sub-limits on Hospital room rents or ambulance charges.

7 Compare the premiums of all the available health insurance policy.

8 Check the hospitals that are enlisted by health insurance coverage.

9 Always check the reviews and feedback of the company online.

10 Also make sure you check the exclusions of certain illness in the policy.

Health Insurance plan for Low Income Earners

For people with low income that live in the United States, the federal government has mandated that states offer a program called Medicaid.  Each state has different eligibility requirements.

Many states have other health-care programs for those who may not qualify for Medicaid - comprehensive coverage may not be included, but certain services like primary care or contraception might be.

States also may offer coverage for children even if a family's income exceeds Medicaid qualification limits. Federally this is known as CHIP or the children health insurance program.

Visit the Centers for Medicare & Medicaid Services to get links to each state's programs: Medicaid Gen Info

And If you do not qualify for Medicaid, check with your state insurance department to see if they have any other programs to help you. If there aren't any other programs available consider a catastrophic health insurance plan which doesn't provide routine care but will provide coverage in an emergency.
Individuals with low income have been receiving subsidies for purchasing health insurance due to health care reform. And the eligibility requirements for Medicaid will also be expanded to cover adults with no children in every state.

Conclusion: we have strategically analyzed all what it takes to fully understand health insurance advantages/benefits health insurance for individuals and low income earners…

What do you have to say? Drop your comments


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