1. What is a deductible?
A deductible is the amount you must pay before the insurance coverage will start paying benefits. However, one of the benefits of health care reform is that preventative services are paid 100% with no deductible for the remainder of the calendar year.
2. What is Out-of-Pocket expense?
This is the maximum amount per calendar year you pay for covered charges. Once you reach the out-of-pocket maximum, the insurance company will pay the remaining covered charges at 100% through the calendar year (Dec 31).
3. What is HSA?
An HSA is a “Health Savings Account” which is a tax sheltered account used to pay medical expenses now and in the future. In order to open this account you must have an HSA compatible health insurance plan. These plans are regulated by the state and federal government and must have minimum and maximum deductible amounts.
For more information on Health Savings Accounts, click HERE.
4. What is a PPO?
A PPO or Preferred Provider Organization is a network of doctors and hospitals that have agreed to provide discounted services to an insurance company. A health insurance policy that includes a PPO will encourage you to use their providers.
5. What is an HMO?
An HMO is a “Health Maintenance Organization”. An HMO combines an insurance company with providers of medical care. (doctors, hospitals, etc) HMO’s are the most restrictive of all health plans where an insured must choose a Primary Care Physician (PCP). This must be chosen prior to enrolling in the plan and this PCP doctor must be seen first before any specialty care is provided. There is generally no coverage for going to a provider outside the HMO network of providers, unlike a PPO, which provides coverage both in and out of network
6. What is individual insurance?
Individual health insurance is a policy that is made available to individuals and families rather than to employer groups. Qualifying for individual coverage can be a challenge. Based on your health history and current condition, insurance companies can “rate” your premiums, which could cost you more, or deny you coverage altogether.
7. What is group insurance?
Group health insurance is a medical plan that an employer may purchase on behalf of employees. Typically the employer will pay at least 50% of the cost and the employees pay the remainder through payroll deductions. Group health insurance must accept all eligible employees regardless of their health history.
8. What is a premium?
A payment to an insurance company for health insurance coverage.
9. What is coinsurance?
Coinsurance is the percentage of covered expenses you share with the insurance company after you have satisfied the deductible. 80/20 coinsurance means the insurance company pays 80% and you pay 20% until your maximum out of pocket.
10. Will I be able to use my HSA account with I turn 65?
Yes. You can still use your HSA for qualified medical expenses; however, you can no longer make contributions to it once you turn 65.
11. Are preventative checkups covered under my insurance plans?
Well- women, and well-men checkups are typically covered. But it’s always a good idea to review plans specifics with your health insurance broker.