Health Insurance

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In the US, health insurance is generally covered by employers as part of the company benefits package. Employer sponsored health insurance plans are subject to a high degree of regulations, and vary greatly between countries that do not have nationalized health plans.

Even if an employer's benefits package includes health insurance, it cannot be assumed that any given pre-existing medical condition will be covered. Moreover, many plans have other exclusions, such as prescription medications, holistic medical treatment, massage, elective surgery (including cosmetic), benign tumors or various psychiatric conditions and treatments. If the availability of health insurance is a key factor in your consideration of a job, be sure to familiarize yourself with its policy provisions and exclusions.

Of special concern are the requirements, costs and availability of health insurance for expat workers who find themselves far from the insurance umbrella provided at home. In an emergency, a decision as to whether to evacuate and repatriate will require knowing whether the employer-provided health insurance will cover the substantial, if not staggering costs of medivac transport or even a flight home.

Likewise, with any workplace health insurance, details, such as whether there is a deductible (i.e., the out-of-pocket non-reimbursed amount) or a required upfront payment before reimbursement, can make a huge difference in how attractive the coverage is.

Health insurance allows an individual to insure himself or herself against the risk of future medical expenses. From the workplace perspective, a group health insurance plan is an employee-welfare benefit plan established or maintained by the employer to provide medical care for the employees or their dependents directly or through insurance, with reimbursement for costs or at no per-incident initial cost to the insured. In general, employer-sponsored health insurance plans usually come with some attached conditions, such as a waiting period before benefits take effect for new employees, that the employee be full time or work a specified number of hours per week, and that employees pay a portion of the premium.

Small organizations, especially those with mostly low-wage employees, are less inclined to offer health insurance as the small workforce translates into a larger cost of underwriting and administration, while also raising the cost of the premium. Moreover, many employees in such organizations prefer compensation in the form of higher wages over health insurance benefits.

Although most employers are not legally required to offer health insurance benefits to their employees, once they are provided, the employer must comply with a number of federal anti-discrimination laws and health plan regulations. Employers have also found that one way to reduce health insurance costs is to provide employees with preventive health screening programs and/or wellness programs in order to encourage them to lead healthier lifestyles.

In America, most corporate employees and their dependents are covered by the employer-sponsored health insurance plans, with the remaining insured through public programs such as Medicaid or private insurance, or are uninsured (as are an estimated 60% of America's poor). Medicaid should not be confused with Medicare: To be eligible for Medicare, an individual must, in addition to meeting citizenship and other requirements, either be at least 65 years old, under 65 and disabled, or any age with End-Stage Renal Disease (permanent kidney failure that requires dialysis or a transplant.) Unlike the Medicare entitlement program, Medicaid is a means-tested, needs-based social welfare or social protection program rather than a social insurance program.

Canadians have a different health insurance menu, with much less dependency on employment for health insurance coverage. For example, irrespective of whether one is employed, provincial for-fee health insurance is mandatory in British Columbia and Ontario for all who meet the eligibility requirements, which include citizenship or permanent residency. Otherwise, in other provinces, essential medical services are free. Private health insurance companies generally cover only whatever is excluded from provincial program coverage.
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