Is Mental Health Covered Under Health Insurance?

For people who depend on any type of private or company insurance to cover the cost of their health needs, the question of whether or not the health insurance policy covers mental health problems is a crucial one for a number of reasons.

The idea of a split between physical health and mental health is an old one, and is a fairly arbitrary decision as to which is which some of the time. From a point of view of health insurance, classifying illnesses or diseases can determine whether or not the insurance company will pay for them, and for many people with mental health issues that can literally be a life or death process.

The term mental health can relate to a condition ranging from a fairly mild form of depression through to serious conditions of clinical depression, schizophrenia, alcoholism, full-blown psychotic episodes etc.

Any health insurance policy should specify exactly what types of illness or disease it is willing to provide cover for and those which it is not. This will also include what it specifies as a type of mental health problem or issue and whether or not the insurance policy provides any type of cover for it.

One of the reasons people are wary of health insurance plans with relation to mental health issues, is that often any type of treatment for a mental health issue relates either to what is known as a talking therapy, or some type of pharmaceutical drug based regime.

Any type of talking therapy that is likely to be effective is likely to be a relatively long-term process, depending upon the nature and seriousness of the illness. Any insurance policy that does cover specified mental health conditions will also provide very strict criteria as to what type of talking therapy is covered, for how long and by whom the talking therapy can be carried out by.

The other issue to be really aware of when looking at any type of mental health coverage under a health insurance plan is the nature of deductibles, co-pay and co-insurance. These terms are essentially ways of getting the person who is insured under the policy to bear some of the cost of the treatment on an ongoing basis in relation to the insurance company.

Most people are familiar with the idea of a deductible, sometimes called an excess, in a policy, but any health insurance policy needs to be looked at carefully in terms of what it’s deductibles are. This is because there are often several different deductibles applicable to the same policy, each for differing amounts and applying to different sections of the policy.

This means that a health insurance policy could have both an individual and a family deductible. This deductible could be separate from another deductible that would apply to specific types of drugs, normally where a distinction is made between a generic and a brand-name drug. The amounts involved in terms of these deductibles can be significant, and when taken in addition to any co-pay or co-insurance amounts can stack up into a sizeable burden that the individual will have to carry for themselves.

In summary, as with any insurance policy, it is important before taking out the policy to have complete clarity about what is and is not covered, as the level of coverage and the specifics of what is and is not covered will vary widely between health insurance policies.

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Health Insurance Plan for Parents and Children

A health insurance plan that covers not only you but your whole family is a solid deal. In a single premium you get to cover up to 15 members of your family. Such comprehensive health insurance plan is called a family floater plan. Since, it is a single policy that takes care of every family member of yours; you are escaped from the task of maintaining records of numerous individual health policies and keeping track of their renewal dates. Also, a family floater policy costs you cheaper than taking numerous individual policies.

As cost of other things rises, the cost of medical expenses also rises. Health insurance policies offer the feature of increasing the sum insured after some years. Sometimes, as a reward for your timely renewal of policy and no claims, the insurance company increases the amount of your sum assured. A family floater policy is a life saver for the house and keeps you ready to face any medical contingency with confidence. In case of medical emergencies, many times the cost of treatment causes more fear and pain than the emergency itself.

For what was earlier considered as a luxury is now a necessity. The service sector has boomed exponentially in India over the past decades. And thus, this boom has passed on economies of scale to the insurance and banking sector as well. The premiums are quite affordable and the service has bettered. The IRDA since its setup in 1999 has taken good measures to regulate the insurance industry and win the trust of masses in insurance. Earlier people were very skeptical whether their claim would be paid or not but that scenario has changed a lot since.

Earlier the only health insurance people used to have was the one done by their employer for them. Apart from that only a select few used to buy it. Some people used to buy health insurance only for the tax benefits. One can get a handsome tax exemption under section 80D, but is not the only motivation to go for a health insurance plan. With increasing awareness people now know how beneficial a health insurance plan is to them.

You can also take health plans exclusively for your parents. Such plans have no entry age limit, cover pre-existing diseases like Diabetes and Cardiac conditions and 100% claim settlement without co-pay.
Aging parents have more medical needs to tender to. If parents are senior citizens you can get additional tax rebate up to Rs. 20000 for the money paid as premium.

Compare health insurance plans to avail the best deal and a plan loaded with attractive and suitable features. Following the experts, one should compare plans of at least three companies before buying. Being more informed about the market, you can take advantage of the competition. Thus, a healthy advice is to do ample market research and evaluation. A healthy family signifies happiness and prosperity!!

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Understanding Policy Clauses In Health Insurance

The clauses that are related to limitations and exclusions may seem complicated at first but it is crucial to understand these before signing up. There could be some exclusions and limitations that may not affect you or your family at all while some may be important depending on your health history and hereditary family history. So while what is excluded for one person may not make a difference, it might make a huge impact for another. That is why it is important to understand what these are and how they impact and relate to you as an individual and to your family in general.

Exclusions are those conditions or expenses that are not covered by the insurance company. In such cases, the claimant will have to share a pre-specified portion of the expenses in the claim if it should ever arise. Some insurance companies will also impose a sub limit that is within the sum insured overall. Exclusions are those expenses that the insurance company need not pay for. The IRDA has standardized this with a list of expenses. There are also different waiting periods for different conditions.

One of the common exclusions for health insurance are pre-existing diseases. This is because the entire premise of insurance is based on uncertainty so if there is a disease that you are already suffering from, it will not come under the insurance. Usually, you can get insurance companies to cover you for a pre-existing disease after a specified waiting period is over.

Another thing that is excluded is pregnancy and expenses related to childbirth and later vaccinations. There could be a waiting period for pregnancy as well, after which there are some benefits that could be availed. Other things that are excluded from a health insurance policy are cosmetic surgeries, dental surgeries, alternative treatments such as Ayurveda and homeopathy, etc.

Sub-limits are another factor which should be carefully looked into at the outset before investing in an insurance policy. A sub-limit is related to exclusions that are associated with doctors’ fees, ambulance costs, rent for hospital rooms, etc. Knowing your sub limits keeps you prepared in case of an emergency so you know exactly what will be covered and what you will have to pay for out of your own pocket.

There are policies which seem to have a whole list of exclusions and sub-limits and there are those that have a moderate amount of them. So knowing what is excluded and what is not will help you make a better decision regarding which health insurance to choose. This can be done easily by doing a systematic and meticulous comparison of health insurance policies taken from different websites or from the agents directly. Knowledge is power and knowing this beforehand helps you in better planning your future and that of your family.

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Five Tips for Choosing the Right Health Insurance Plan

One of the best ways of safeguarding your personal well-being is by having a health insurance plan. Due to the large number of companies that offer this type of insurance policy, choosing the right one can be a daunting task. Here are five tips to help you find the best plan on the market today.

Check the Networks of Different Plans

If you have a select group of doctors whom you prefer, ask them which insurance networks they are part of. You can also use one of the many accredited online directories to know the networks that each plan on your list has. On the other hand, if you just relocated to a new city and you do not have a preferred doctor yet, choose a plan that has a large network of health practitioners.

Know the Maximum Premium Budget

Consider your average monthly expenses to know the amount of money that you can spend on the policy without compromising your financial capability. Low premiums often result in high out-of-pocket costs. Hence, what appears to be the cheapest plan may really be the most expensive, as you will be forced to pay for most of the services. One of the best ways of choosing the right premium is by estimating the total amount of money that you spent on health care last year, including out-of-pocket expenses and premiums. Then, choose a plan that has similar monthly deductibles, copays, and premiums. A high premium plan will save you thousands of dollars on out-of-pocket costs if you require expensive procedures or frequent medical care services.

Look for Additional Benefits

In a bid to attract more clients, insurance companies usually offer policies that have additional benefits apart from medical coverage. Based on this fact, it is wise to check the summary of benefits of each policy on your list until you find one that has your preferred scope of services. For instance, some policies provide better coverage for mental health and physical therapy care while others have more comprehensive emergency coverage.

Research Plan Structure

Once you have an estimate of your monthly premium, your next step is determining your ideal plan structure. Some of the most common plans are HMO, EPO, POS, and PPO. The plan that you select will determine which doctors you can see and your costs. More often than not, plans that have referrals, such as POS and HMO, require that you first consult a primary care physician before booking an appointment with a specialist. If you already have a network of doctors that you prefer to see, eschew plans that they do not take.

Compare Out-of-Pocket Costs

Your preferred health insurance plan should clearly indicate the services that you will be required to pay for and the amount. The sum amount includes coinsurance, co-pay, and deductible. A plan that has low out-of-pocket costs is an ideal choice if you regularly need emergency services, take expensive medications, have scheduled upcoming surgery, or were recently diagnosed with a chronic condition such as cancer or diabetes.

Finally, make sure that the health insurance company is legally accredited, reputable, and reliable to cushion yourself from any inconveniences.

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Buying Health Insurance Through a Broker

In its most simple definition, a health insurance broker (also commonly known as an agent) is someone who is licensed to sell health insurance. However, there are many other services they provide you that fall under the umbrella of selling health insurance. Here are some of the most important:

Perhaps the most important fact to know about working with an agent is that it’s free. Insurance agents are paid by insurance carriers, not by consumers. So don’t worry about having to pay some service fee for signing up for a plan with an agent, because it will cost you nothing more than if you were to do it yourself

Health insurance is confusing, and an agent will explain it to you until it makes sense. Ask all the questions you want, that’s what they’re there for. Want to know what your coinsurance will be on a certain plan? Want to know what coinsurance even means? Ask away!

An agent can help you compare plans that you’re interested in. When you let an agent know what it is you’re looking for, they will narrow down your possibilities and explain the benefits of each. They can check to see if your doctors and preferred medical facilities are in-network, and they can just to see if any prescriptions you take are covered (and how much).

Your agent is your agent as long as you have your policy. This means that you have someone you can contact when you have questions or even when you want to shop around for a new plan. You’ve got someone in your corner, as opposed to just winging it and picking out a plan on your own.

Because I’m sure you don’t want to be here reading all day, those are only a few of the biggest benefits of using a licensed agent to buy health insurance. That’s not even including how much time and frustration an agent can save you (we’ll save that for another article!).

To make it even more convenient for you, many brokers have the ability to access plans that are both on and off-exchange (government-run Marketplaces for health insurance). This provides you with even more options. Additionally, for agents who can access on-exchange plans, they can also determine your subsidy eligibility that can lower your premium and out-of-pocket expenses. Again, saving you yet another headache.

The next time you need to enroll in or change a health plan, keep a licensed agent in mind- it won’t cost you anything, but it will certainly save you a lot.

Angela is the Media Content Writer for Health Choice One, a health insurance brokerage that charges nothing to help individuals and families get health coverage. Health Choice One works with major medical plans like those discussed in this article. Additionally, agents can help you enroll in short-term and supplemental plans if you’re not currently eligible to enroll in a major medical plan.

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