How Does Health Insurance Work?

Health insurance is the most important insurances of all. It helps cover your medical bills, regardless of the amount involved.

It is fairly affordable to treat what might be a mild health condition. We, as human beings are vulnerable to potential diseases and accidents that might result in hazardous health condition.

Such as serious illnesses, disabilities, and injuries. These all can be life-threatening sometimes. The expenses that come with the treatment and surgical procedures involving such circumstances are not always in the gamut of our income.

This is where health insurance steps in to save us not only from the fatality of our health condition but also from the potential bankruptcies.

That being said, going for health insurance coverage can be a difficult process. Thus it is always wise to go for a coverage plan that is not too convoluted in its conditions and can be tailored according to your needs, such as that of USHealth Group Jobs.

Before seeking a health coverage plan, it is essential to know how does health insurance work.

How Does It Work?

Like any insurance, health insurance consists of a legal contract between the health insurance company, i.e. provider of the insurance and the policyholder, i.e. you, the receiver of the insurance.

The dynamics between the two parties are, thus, regulated under the terms and conditions defined in the contract. Below are the important factors that need to be known and are to be taken into account to understand the mechanics of health insurance.

The Deductible

This is the preordained amount that is supposed to be paid out of your pocket before your health insurance services begin. All the benefits that come with a health insurance plan will only be activated once you reach your deductible amount, which can be paid at once or in successive episodes.

The deductible is the maximum amount paid by you in your health insurance plan. For instance, if your deductible is $20000, then you have reached that amount to enjoy your health coverage benefits.

 Monthly Premiums

Monthly premiums are the monthly fees that you pay in return for your availing of the insurance policy. Each company has its amount of fees based on their policies.

Monthly premiums should not be confused with a deductible which is an amount you pay for activation of the health coverage, as well as the ‘limit’ from where your health insurance will step in to help you pay your medical bill.

In contrast, the monthly premium is the amount you pay for having the health coverage.


Coinsurance is another set of amount albeit relatively small, paid by you while covering your medical bills. With coinsurance, you share the responsibility of paying your medical bills with your insurance company.

The expenses are divided into two percentiles, wherein the policy covers most of the percentile of your medical expenses. For instance, if you have agreed upon a 20% payment, then the rest of the 80% payment will be covered by your health insurance plan.

is important to remember that the coinsurance will only apply once you reach your deductible amount. If your medical bill, is, say, less than less 20000 dollars, which is your deductible amount, then you will have to pay the whole bill.

But, if your medical bill reaches your deductible amount, then you will have only to pay 20% of 20000 dollars, which will be only 4000 dollars, whereas your insurance will pay rest of 16000 dollars.


Copayments, also colloquially referred to as copays, is the amount you pay to your health insurance plan every time you visit a clinic or hospital.

The copayments are fixed for medical services they correspond to, which means you will have to pay the same amount every time you avail of a particular medical service allotted for that amount. Therefore, the different a medical service, the different an amount will be.

A visit to a specialist will have a higher rate than a visit to a physician.  Similarly, visiting a local clinic will much cheaper than visiting a specialized hospital. Keeping into account all of this, the service of emergency rooms is likely to cost the highest.

The Network of Your Health Insurance

It would be illogical to assume that your health plan would cover every hospital you visit. The network of your health insurance is limited to a group of hospitals and doctors covered by your plan.

Therefore, health insurance will not pay if you will seek out network care. However, there are many instances in which health insurances do sometimes pay for the out network services:

Unavailability of in-network services

Suppose you are in a different city than those covered by your health plan, and suddenly you get seriously sick, and are not in a position to avail the services of a specialist or an emergency room.

Then your health insurance will likely be willing to transgress its laws and help you pay for the out network care at the same rate as that of an in-network.

Natural disaster

If the in-network services covered by your policy are affected by some natural disaster, then your health insurance will help you to avail the out network services.

So, if an earthquake, flood, or even disasters caused by some human error such as fire have rendered the in-network services of your area out of order.

Here your health insurance plan will come up with a makeshift solution of providing services from out network places.


Health insurance can seem very costly at first since you are made to pay a hefty amount equivalent to buying a new house, but keeping a long-term view of things, the amount is ever so justifiable.

This is because, as in with every insurance, you are securing your future, and perhaps the most important part of that future – your health. There is no foreseeing to the terrible illnesses, accidents, or another similar turn of events that might leave you handicapped.

Health insurance then helps you sidestep these tragedies all the while securing your financial circumstances.

Kingsley Felix
Blogger and Editor here on Healthtian and other Krafty Sprouts sites, I make sure things run smoothly as they should.

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  1. The impotance of subscribing to health insurance packages cannot be overemphasized. No one plans to be ill or to be an accident victim. However, if these things ever happen, the insurance package can be your saving grace.

    Once again, great job with this article and site at large!


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