What Does This Mean? |
Confused by the insurance speak? We've helped decipher some of the most common terms. Coinsurance – Once you have paid your deductible, you start sharing the bill with your health plan. A popular arrangement is an 80/20 or 80% of the bill gets paid by the health plan and you pay 20%. Hypothetically: you get a doctor bill for $100 the health plan will pay $80 and you will pay $20. Out of Pocket Maximum – Once you have met your deductible and start paying your co-insurance you will continue to pay your portion of coinsurance until you hit this total. Here’s a hypothetical: Here is how it would break down. $14,000 - $1,500 (deductible) = $12,500 So – Health Plan $11,500 You $2,500 Copay - is a fee that is agreed on ahead of time that you pay for the service. It doesn’t count towards your deductible or coinsurance. For example: The “Blue Plan” has an office visit copay, it is $30 for the office visit only, just the doctor’s time. Universal Copay (like on the Green Plan) If you go to see your family doctor and in his office you have your blood taken and an x-ray – it’s one copay. But, if they send it to a lab or it’s done by another provider, then it’s usually another copay. Well Care Visit – Go get checked out man! The health plan covers a comprehensive physical examination that is outlined in your policy. Each plan has a different price for the benefit. If you can catch it early, there is a greater likelihood that it will be no big deal! Pre-existing Condition – There is a 12 month waiting period ONLY if you have a pre-existing condition and have not had creditable coverage. If you have had coverage, you can reduce or even eliminate this waiting period all together. Exclusionary Rider – This means your application was reviewed and due to a condition that you may have, it was decided that condition can’t be covered by the policy due to its potential expense. So, we still give you coverage, except for that condition. |
