Insurance World

Health is the biggest and most crucial asset of every living being. An unhealthy animal and individual can never truly experience any joy. It is the wealth of health that provides the requisite potential to topple over all odds and to move ahead with life. So such an essential part of a person’s life demands extra care and concern. An ideal way to secure an individual’s prized possession for him and for those who love him is a health insurance policy.

A health insurance policy is meant to financially assist a person in case there occurs a setback to his health. For instance he is afflicted by some grave disease, meets an accident, becomes handicapped etc. In order to provide complete service and for the all round development of the individual the health care system of America offers ample of options or different types of health insurance for its citizens. Some of these are explained below:

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Preferred Provider Organization or PPO is a discount form of health insurance policy. PPO has a complete network of health care providers from hospitals to doctors. If an individual has taken PPO policy and takes treatment from any of these assigned providers, the PPO covers his complete medical treatment. While if the person takes recourse to some other doctor or institution, he gets served at a reduced rate. PPO’s thus facilitate medical services at abridged rates.

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One immensely cheap form of health insurance is the catastrophic health insurance. This sort of policy is basically meant for the people who have the financial means to manage regular illnesses and hospitalizations. The deductibles i.e. the sum of money an individual for these policies are quite large for this policy. At times there are caps on the amount the policy will pay in case of illness.

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A Short term health insurance policy is akin to a life insurance policy in the sense that both can be adopted for a specific tenure. This policy covers catastrophic to comprehensive cases and excludes the situation of pregnancy and childbirth. Quite often it is hard to qualify for these policies as there are strict conditions or qualifying procedures. Moreover these policies may not cover any pre-existing medical conditions.

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HMOs or the Health Maintenance Organizations also offer health insurane t significantly lower premiums. But the disadvantage is that they confine the sources a person may seek in non-exigency situations. HMOs do not cover the precautionary measures such as immunization, mammograms and physicals. There are quite a few issues associated with the HMOs. For instance it is believed that doctors receive financial perks for deducting the cost of medical services to patients. One way to do this is to pay monthly fee to the doctor for each patient despite of delving in to the issues of what treatment the latter one needs.

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There are also full-service health insurances. The lucrative feature of these policies is that they cover all sort of illnesses, cover any medical treatment the patient takes regardless of the institution or doctor and the deductibles are at the discretion of the policyholder. He may pay a high or a low one.

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Medicare or Medicaid insurances are meant for the retired or the low-income individuals.

About 87 percent of the residents of Germany have statutory health insurance, i.e. GKV. As of May 2005, the GKV relied on 321 non-profit sickness funds to collect premiums from their members and pay health care providers according to negotiated agreements. Those who are not insured this way, mainly civil servants and the self-employed, receive health care through private for-profit insurance.
An estimate of 0,3 percent of the German population (around 250,000 people) has no health insurance at all. Some of them are so rich that they do not need it  but most of them are poor and receive health care through social assistance.
Statutory health insurance
There are three different categories of sickness funds: primary funds, substitute funds and “special” funds. Some workers are required to be members of the primary funds, e.g. if they earn less than the than the income ceiling (2006: EUR 3,937.50 per month / EUR 47,250.00 per year). Those earning more than that ceiling may be members on a voluntary basis, or they may have a choice of funds. Some of them automatically become members of a particular fund for example because of their occupation (company-based funds) or place of residence (local sickness funds). Some occupations have their own “special” funds, e.g. farmers or sailors.
Substitute funds are divided into two kinds: they provide health insurance to both white collar workers and blue collar workers earning more than the income ceiling. Membership is voluntary.
Both, employers and employees pay half of a member’s premiums, which in 2006 averaged between 13 and 14 percent of a worker’s gross earnings up to the contribution assessment ceiling (2006: EUR 3,562.50 monthly / EUR 42,750.00 p.a.). Premiums are fixed according to earnings rather than risk and are unaffected by the respective member’s marital status, family size, or health. Premiums are the same for all members within a particular fund with the same earnings.
Private health insurance
About eleven percent of Germany’s residents pay for private health insurance provided by some 40 for-profit insurance carriers. Many of those choosing private insurance are civil servants who want to secure percentage of their medical bills not covered by the government. Some sickness-fund members buy additional private insurance to cover such extras as a private room or a choice of physicians while in a hospital. Otherwise, the medical care provided to the publicly and privately insured is identical. In both cases the same medical facilities are used. Self-employed persons earning above the income ceiling must have private insurance. Members of a sickness fund who leave it for a private insurance carrier are not allowed to return to public insurance.
As opposed to the statutory heath insurance, contributions to the private insurance depend on the member’s age, gender, occupation and health status, that is, the individual risk. Although private insurance companies pay health care providers about twice the amount paid by the primary sickness funds, private insurance is often cheaper than statutory health insurance, especially for younger policyholders without dependents. As is the case for members of sickness funds, employees who have private insurance have half their premiums paid by their employers.