Here is a brief run-down of certain words, you can expect to see in relation to
health insurance. To understand what these terms can help you make the right choice when you choose a health insurance plan.
Eligible: The maximum amount an insurer will pay for a medical procedure.
Co-insurance: Some insurance plans require you to pay a percentage of the cost of covered medical services (usually between 20% and 30%). For example, your insurance company would pay 80% and you pay 20% of the cost of a medical examination. The amount you pay is the co-insurance.
Co-payment: Some insurance plans require that you pay a flat rate for medical services covered. For example, you might pay a co-payment of $ 10 or $ 15 for a visit to a doctor. More expensive procedures generally involve co-pays.
Deductible: The amount is to cover medical expenses your insurance policy before paying. Franchises are typically done on an annual basis. For example, if your deductible is $ 250, you must pay this amount from your own pocket each year before your insurance company cover the cost to start.
Fee-for-service (FFS) plan: A type of health coverage to not to be limited in your choice of doctor or specialist. FFS plans typically require payment of a deductible and co-payments or co-insurance.
Flexible Spending Account: Provide users with a way to pay medical expenses not covered by insurance, such as deductibles and co-payments.
Health Maintenance Organization (HMO): An organization that provides low-cost insurance for large groups. The policy holders must pay providers in the HMO's provider network to be eligible for insurance, and must also choose a primary care physician.
Savings Account Health: Combine a savings account with a high deductible health plan. The savings account can be funded with pre-tax dollars, which can be used to pay deductibles and other expenses.
Out-of-pocket maximum: The amount of co-insurance, you must pay before your insurance company will pay 100% of the authorized amount for out-of-network claims
Point of Service (POS) Plan: A plan for health care management that allows you to choose among providers and exit the network. However, outside of a network of care is more expensive, with a deductible and co-insurance or co-pays required.
Preferred Provider Organization (PPO): An option of managed care in which members may choose to go outside the network of providers, but must pay more for doing so.
Primary Care Doctor (PCD): Anyone enrolled in an HMO must choose a primary care physician (from a list of participating providers), which coordinates health care and provides specialist referrals in case necessary. The SCI can be a general practitioner, family physician, pediatrician, or even an obstetrician.
Referral: An authorization of your primary care physician to see a specialist or to receive one or a special test procedure. HMOs generally require that you obtain a referral for specialized care and procedures, while some of the managed care plans allow you to self-reference.
Scale of allowances: your policy covers, for each procedure.
Self-Directed Health Plan: a flexible health care focuses on preventive health care coverage through regular checks, diagnostic tests and screening and vaccination.
Specialist: A doctor who is trained to a specific type of medicine, such as cardiology, dermatology and neurology. Some plans require that you get a recommendation from your doctor before primary care, you can see a specialist.
Insurance: prescription, dental and vision plans are not always included in standard plans for health care. On the contrary, they may be offered in the form of additional plans that can be achieved in conjunction with a management plan for health care.
