Many employers offer health insurance to their workers as part of a package of benefits. This kind of insurance helps to defray expenses for medical services like general check-ups, outpatient surgery, stays in the hospital, drugs and other kinds of medical costs. The employer will often pay for some or most of the monthly premium while the employees contribution is taken directly from their pay.
Health insurance companies make arrangements and agreements with certain physicians and medical facilities or networks. When one is in need of medical service, generally he or she is best served by visiting a contracted medical provider. To provide an example, when one who is insured has an office visit with the doctor, the doctors charges can sometimes be around $85. With a contracted provider, the rate can be substantially discounted that the insured person and the insurance company pays. If it is $60 and the insured person has a copay of $25 then the insurance company picks up the balance of $35.
Employers usually offer a few different plans from which the employee can pick. Most plans are engineered so that the insured must first meet a deductible before the insurance company begins to fund their share. Once this deductible amount is met, the insured the only pays his or her agreed upon portion. Called “coinsurance” it gets applied to what is known as the “maximum out of pocket.” When the insured consumer pays the deductible and the maximum out of pocket amount, the insurance company then will normally pay all of the cost. Most health insurance plans have copays which are upfront payments for certain medical services utilized, like a simple doctor’s appointment for example. These copays often cannot be considered a part of the deductible or out of pocket costs.
Under the Affordable Care Act, insurance companies are now obligated to pay for all normal preventative services. Though it is sometimes a challenge to meet the deductible and out of pocket costs, having a good policy will prevent you from having to come up with tens of thousands of dollars in the event of something catastrophic happening. Having insurance through an employer is one of the best ways to help pay for what can be huge medical expenses.