Understanding Health Insurance: Key Functions & Coverage

A typical health insurance plan provides four primary functions: provisions for routine care, emergency medical assistance, chronic condition treatment and pharmaceutical care. Different health insurance plans pay for all of these functions in differing amounts, and the premiums differ as well. Often, individuals will get access to a health care plan through their employer, which sometimes provides assistance on premium payment. As long as the individual remains current on their health insurance premiums, they can count on receiving coverage.

Routine Care

Routine procedures include physical examinations, regular tests, vaccines, booster shots and care for minor illnesses. Visiting a doctor regularly is important to ensure that no serious conditions develop. In general, the earlier that a serious condition is diagnosed by a doctor, the better the chances for recovery. Depending on the level of health care offered by the insurance plan, there may be no, some or complete coverage for such routine visits within certain limitations.

Emergency Care

Emergencies include sudden injuries, acute illnesses, drug overdoses and other unexpected medical calamities. The emergency coverage provided by health insurance typically exceeds that for more predictable illnesses because of the reduced chances of their occurrence. This usually means a higher maximum payment and a lower deductible specifically for emergencies. Emergency coverage can cover ancillary costs like ambulance fees as well.

Chronic Conditions

Chronic conditions often require repeated treatment, extensive intervention and continual testing. As long as it's not a pre-existing condition, health insurance companies will usually cover a bulk of the costs associated with such medical issues.

Pharmaceuticals

Pharmaceutical treatments, as long as they are prescribed by a doctor, are usually covered in large part by insurance plans. The deductible for pharmaceuticals can sometimes be quite high depending on the plan. As pharmacology is critical to the practice of modern medicine, almost every health insurance plan provisions for at least some pharmaceutical usage for plan holders.