Health Care Coverage Details
Plan Details
Health care is one of the vital needs for any human being in the modern society. In the American health care system, various plans are possible for people depending on their needs and opportunities. This paper discusses the Tricare health plan and considers the situation of health coverage loss for non-military people.
The health care coverage plan that I am currently protected by is the Tricare Prime for Military Spouses. The source of this health care coverage is my family. One of the most important benefits of the Tricare Prime for Military Spouses is the absence of the out-of-pocket costs during the coverage plan effectiveness while the specially assigned primary care manager (PCM) provides you with the necessary health care services (Tricare, 2009). Drawing from this, my health care plan cover 100% of my health needs during the specified period of time, and the only costs this plan involves are the network provider services that include $11 per day of the network functioning and $12 per visit of a specialist in the form of copayments.
Exclusions and Limitations
Although Tricare Prime covers a rather substantial share of health care needs, it has certain exclusions and limitations. Thus, acupuncture, artificial insemination, autopsy, diagnostic admissions, electrolysis, learning disability services, sterilization reversal surgeries, X-ray, laboratory, and pathological services not related to a specific illness or injury constitute the incomplete list of the services that are excluded from the Tricare coverage under all circumstances (Tricare, 2009). There is also a list of services covered by Tricare only if a Tricare-related or a Tricare-authorized organization or professional carry out those services. This list includes abortion (only if without one a mother’s life will be endangered), cardiac rehabilitation, dental care and X-rays, plastic surgery, genetic testing, and weight reduction procedures (Tricare, 2009).
Non-Military Coverage Loss
COBRA
The people with no access to military based health care coverage plans are often subject to the threat of losing their coverage because of some reason. The Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1986 regulates the rights of people whose health coverage was terminated due to a certain event to be eligible for health care coverage even after that event (U.S. Department of Labor, 2007).
For example, if a person loses his health care coverage due to resignation from the job or reduction of the working hours, COBRA provides this person with the possibility to retain health care coverage under the same plan that this person had while employed. Moreover, this person’s spouses or other family members are also eligible, under COBRA, for the health coverage under their prior plans (U.S. Department of Labor, 2007).
HIPAA
Another tool to help those who lose their health care coverage is Health Insurance Portability and Accountability Act of 1996 (also known as HIPAA). This act regulates the relations between employers and employees regarding health care coverage plans (U.S. Department of Labor, 2007a). In more detail, HIPAA prohibits the change of the health care coverage plan or deprivation of such a plan for any employee by a new employer. Thus, if a person works under a specific health care coverage plan, the new employer of this person cannot change his/her plan or deprive this person of health care coverage at all (U.S. Department of Labor, 2007a). Thus, both COBRA and HIPAA serve as protection tool for people who can lose their health care coverage plans due to some reasons.
References
Tricare. (2009). Tricare Prime. Web.
U.S. Department of Labor. (2007). Frequently Asked Questions about COBRA Continuation Health Coverage. Web.
U.S. Department of Labor. (2007a). Frequently Asked Questions about Portability of Health Coverage and HIPAA. Web.