Important Health Insurance Terms to Know
Being informed about insurance lets you make the wisest choices for your personal health. Unfortunately, it can be a little tricky for the average person to understand what insurance companies are actually talking about. It might seem overwhelming, but once you learn a few basic terms, you can see exactly what an insurance plan is trying to say. Here is a glossary that explains tough insurance terms in simple language.
Benefits
Benefits are all the services your insurance company will give you. According to the Affordable Care Act, all insurance companies have to include ambulatory patient services, emergency services, mental health services, laboratory services, habilitative devices, hospitalization, maternity care, pregnancy, prescription medications, rehabilitative services, preventative medication, and pediatric services in their benefits.
Covered and Excluded Services
A covered service is something where your insurance will pay at least part of the costs. An excluded service is something you have to pay for yourself that will not count towards any deductibles or out-of-pocket maximums.
Deductibles
The way insurance works, you start out by paying all costs yourself. Once you hit a limit of total expenses, which is called your deductible, the insurance will start paying their portion.
Coinsurance
Coinsurance is the percentage of a health cost that the insurance plan will cover.
Copayments
This is a set amount you have to pay for a specific service. For example, you might just pay $20 every time you visit the doctor.
Out of-pocket Maximum
Just like the deductible, this is a limit you can reach while paying for services. Once your out-of-pocket expenses hit this limit, you no longer have to pay copayments and coinsurance. Your insurance will pay 100 percent of all covered benefits once the maximum is reached.
Pre Existing Conditions
These are conditions that you had before you got insurance. These include things like high blood pressure, asthma, diabetes, and cancer.
Now that you know a little more about insurance terminology, it will be easy for you to find the right plan for your needs. If you would like to learn more about how health insurance works, call Schnitzer-Slate Insurance Agency at 910-338-0686.
Benefits
Benefits are all the services your insurance company will give you. According to the Affordable Care Act, all insurance companies have to include ambulatory patient services, emergency services, mental health services, laboratory services, habilitative devices, hospitalization, maternity care, pregnancy, prescription medications, rehabilitative services, preventative medication, and pediatric services in their benefits.
Covered and Excluded Services
A covered service is something where your insurance will pay at least part of the costs. An excluded service is something you have to pay for yourself that will not count towards any deductibles or out-of-pocket maximums.
Deductibles
The way insurance works, you start out by paying all costs yourself. Once you hit a limit of total expenses, which is called your deductible, the insurance will start paying their portion.
Coinsurance
Coinsurance is the percentage of a health cost that the insurance plan will cover.
Copayments
This is a set amount you have to pay for a specific service. For example, you might just pay $20 every time you visit the doctor.
Out of-pocket Maximum
Just like the deductible, this is a limit you can reach while paying for services. Once your out-of-pocket expenses hit this limit, you no longer have to pay copayments and coinsurance. Your insurance will pay 100 percent of all covered benefits once the maximum is reached.
Pre Existing Conditions
These are conditions that you had before you got insurance. These include things like high blood pressure, asthma, diabetes, and cancer.
Now that you know a little more about insurance terminology, it will be easy for you to find the right plan for your needs. If you would like to learn more about how health insurance works, call Schnitzer-Slate Insurance Agency at 910-338-0686.