What those insurance terms really mean

It seems like every year insurance companies impose new deductibles and co-pays for their health insurance. The problem is some people don’t know what those terms actually mean. Below are a list of the common terms and what they actually mean.

Health Savings Account - Plan that allows you to contribute pre-tax money to be used for qualified medical expenses. HSA’s must be linked to a high-deductible health insurance policy. We accept HSA’s as payment.

Coinsurance - Money that an individual is required to pay for services after a deductible has been paid. In some health care plans, co-insurance is called “copayment.” Coinsurance is often specified by a percentage. For example, the employee pays 20 percent toward the charges for a service and the employer or insurance company pays 80 percent. Most PPO’s have coinsurance,

Copayment is a predetermined (flat) fee that an individual pays for health care services, in addition to what the insurance covers. For example, $15 copayment for each office visit, regardless of the type or level of services provided during the visit. Copayments are not usually specified by percentages. Most HMO’s have Co-pays.

Deductible - the amount an individual must pay for health care expenses before insurance covers the costs. Often, insurance plans are based on yearly deductible amounts. Most PPO’s have a deductible and most HMO’s do not have a deductible

Effective date - the date your insurance coverage begins.

In-network refers to providers or health care facilities that are part of a health plan’s network of providers with which it has negotiated a discount. You usually pay less when using an in-network provider. We are in-network with most insurance companies (Anthem, Blue Shield, Kaiser, Cigna, Aetna, etc...)

Pre-existing condition is a medical condition that is excluded from coverage by an insurance company because the condition was believed to exist prior to the individual obtaining a policy from the particular insurance company.

Pre-Authorization - some insurance requires a primary care physician to approve treatment before it will pay for it.