What is Health Insurance?


Health insurance is coverage that provides for the payments of benefits as a result of sickness or injury. Includes insurance for losses from accident, medical expense, disability, or accidental death and dismemberment.

Let’s face it, medical treatments aren’t cheap.  Without health insurance coverage you could end up paying off medical bills for the rest of your life.   UPNIN Insurance can help you find an affordable healthcare plan that’s right for you.   Call 855-99-UPNIN  and talk with one of our friendly agents today to learn more.

What are the major types of health insurance policies in Texas? There are basically three major types of health insurance policies for Texas residents to choose from–consumer-directed, fee for service, and managed care.  These health insurance plans help cover your medical, surgical, and hospital expenses.  They may even cover dental expenses, mental health services, and prescription drugs, depending on the coverage you choose.

Consumer-directed - A consumer-directed health plan (a.k.a. “consumer-driven” or “consumer choice”) is a newer type of healthcare plan that’s designed to give you more control. As part of the plan, you setup a health fund that can be used to cover medical expenses.
Fee for ServiceA fee for service plan is a more traditional healthcare plan. It means you pay a fee to your provider for every healthcare service you receive. The benefit of this type of health insurance plan is that it allows for a lot of flexibility when choosing a physician or healthcare provider.

Managed Care- Members of managed care health plans generally enjoy more benefits like lower out-of-pocket costs. However, you can only receive treatment from physicians that participate in the managed care network. Typical managed care plans include health maintenance organizations (HMOs), preferred provider organizations (PPO), and point-of service (POS) plans.
Common Health Insurance TermsWhen discussing health insurance with a UPNIN Insurance  agent, it helps to understand some of the common terms you’ll run into. Below you’ll find definitions to some of the most common health insurance terms.

Deductible–the amount of money you pay toward medical bills before your insurance coverage begins.
Co-pay–a specified amount of money you pay upfront for doctor visits and prescription refills.
Coinsurance–the percentage of medical bills you pay after meeting the deductible.

Health Maintenance Organizations (HMOs) and Exclusive Provider Organizations (EPOs)
  • HMOs and EPOs may limit coverage to providers inside their networks. A network is a list of doctors, hospitals, and other health care providers that provide medical care to members of a specific health plan. If you use a doctor or facility that isn't in the HMO’s network, you may have to pay the full cost of the services provided.
  • HMO members usually have a primary care doctor and must get referrals to see specialists. This is generally not true for EPOs.

Preferred Provider Organizations (PPOs) and Point-of-Service plans (POS)
  • These insurance plans give you a choice of getting care within or outside of a provider network. With PPO or POS plans, you may use out-of-network providers and facilities, but you’ll have to pay more than if you use in-network ones. If you have a PPO plan, you can visit any doctor without a referral.
  • If you have a POS plan, you can visit any in-network provider without a referral, but you’ll need one to visit a provider out-of-network.

High Deductible Health Plan (HDHP)
  • High Deductible Health Plans typically feature lower premiums and higher deductibles than traditional insurance plans. 
  • If you have an HDHP, you can use a health savings account or a health reimbursement arrangement to pay for qualified out-of-pocket medical costs. This can lower the amount of federal tax you owe.

​Catastrophic Health Insurance Plan
  • A catastrophic health insurance plan covers essential health benefits but has a very high deductible. This means it provides a kind of "safety net" coverage in case you have an accident or serious illness. 
  • Catastrophic plans usually do not provide coverage for services like prescription drugs or shots. 
  • Premiums for catastrophic plans may be lower than traditional health insurance plans, but deductibles are usually much higher.