What is Health Insurance?
Health insurance is a contract where an insurer pays part of medical expenses in exchange for premiums. It may cover doctor visits, hospital stays, surgeries, prescriptions, and preventive services.
Major Types of Health Insurance:
- Individual Insurance: Purchased by individuals or families.
- Group Insurance: Provided by employers for employees.
- Government Programs: Medicare, Medicaid, CHIP, etc.
Key Terms:
- Premium: Regular payment to keep coverage.
- Deductible: Amount paid before insurance kicks in.
- Copayment: Fixed fee for specific services.
- Coinsurance: Shared cost after deductible (e.g., 20%).
- Out-of-Pocket Maximum: The most you pay in a year.
Texas Requirements:
- Policies must be approved by the Texas Department of Insurance (TDI).
- Required coverage for certain services (e.g., maternity, mental health).
- Must include a clear explanation of benefits (EOB).
🧠Flashcards – Lesson 5
- Q: What is health insurance?
A: A contract that pays medical expenses in exchange for premiums. - Q: What is a premium?
A: The amount paid regularly to keep health coverage. - Q: What is a deductible?
A: The amount you pay before insurance starts paying. - Q: What is coinsurance?
A: A shared cost after deductible, such as 20% of charges. - Q: What is the out-of-pocket maximum?
A: The most you pay in a year before insurance pays 100%. - Q: What department regulates Texas health insurance?
A: Texas Department of Insurance (TDI).