How Does Health Insurance Work: Understanding Benefits

Are you seeing the ever-increasing cost of medical care? Yes, that is happening with everyone around the globe.

While one is traveling to seek medical assistance abroad OR going to the specialists around their local areas or within the country.

It is all going to cost for sure.

And then comes the real turn of signing up for a good insurance program.

But is it only enough to just subscribe to it and be all done?

Of course, not. It is not really the single entity to just go for it and you are all done.

What we really have to understand besides the cost and the monthly premiums, to know how does the health insurance really work.

So, how does it really work and we will tell you all.

How does health insurance work

How means the procedure.

The reasons.

And understand the benefits that we may count on the insurance that makes it work.

  • Premiums
  • Deductible
  • Co-insurance
  • Out-of-pocket maximum
  • In-network
  • Out-of-network
  • Pre-existing condition
  • Co-payment
  • Waiting period
  • Enrollment/open period


You pay the amount monthly or yearly (as decided at the time of subscription) to your insurance company to keep it active. 

And that is the one vital element of the 


This is the term used for paying the amount to must pay before your coverage initiates.

Normally, it is set at the rounded amount such as US$ 500.00 or US$ 1,000.00 that you must pay per medical assistance and if you are billed US$ 2,500.00 and your deductible is set at US$ 1,000.00, the rest of the US$ 1,500.00 will be paid by your insurer.


It is the part of the amount that one owes to the medical provider once the deductible has been paid.

If your co-insurers of the plan is set at 20 % and you are billed for US$ 200.00, that means you are to pay US$ 40.00 in co-insurance.

Out-of-pocket maximum

Anything that you pay in the name of deductibles and co-insurance charges within a year before your insurance company starts to pay off all of the covered expenses, is called out-of-pocket maximum.


Got in-network coverage within your policy. With in-network, the physicians and medical that attend the patient services which cost so-less and one of the cheapest options for policyholders. The pool of physicians and the medical establishments that have talked out their budget and are up with their lowered rates.


Those physicians and the medical establishments that are not covered in your insurance policy but still if the patient requires immediate assistance and the chance is there for the out-of-network availability, they would cost so much higher than the in-network ones.


With co-payment, you get to pay the full amount when you see a physician or specialist without waiting for the deductible to be paid out.

Waiting period

The employer-sponsored insurance plans where they would have to wait for a period of 90 days before the employees would be allowed to enroll in the insurance plans.

Enrollment/open period

This provides the window of time where you can apply for the health insurance of modifying the plan to include your spouse and the children.

When the enrollment window time is expired, the policyholders would not be able to seek modification in their plan until the next enrollment window does not open unless if you experience to qualify the life event such as marriage, birth of a child, divorce, change in the individual and household income, or the relocation of interstate residence.

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