Terminology of Health Insurance Policies

When all you want to do is protect your health and that of your family, the work of finding a health insurance policy that is right for you can sometimes be stressful and confusing. If you are armed with some facts as you start the process, hopefully it will go smoothly for you.

First, you may read and hear terminology that is unfamiliar but common in health insurance policies. Arranged alphabetically, here are explanations of health insurance terminologies that are mentioned all the time:

Comparing Health Insurance Policies of Different Insurers

Benefits : These are the services you receive under your policy that are paid by the insurer. They can range from coverage of drugs to percentage paid for office visits. Basically, benefits are what you receive in exchange for paying the insurance company.

Claim : This is a request from you to the company to issue payment for a service.

Co-payment : You may be responsible for this amount each time you make a doctor visit or pick up prescription drugs.

Deductible : Every plan varies, but with some, you agree to pay a certain amount of health care costs. For example, you could be responsible for $200 of hospital bills and then the insurer will pay the rest. Deductibles vary widely and are very important numbers for you to consider as you compare different health plans and look at each company.

Family History and Projected Income

When making a decision which insurance company to choose, it helps to look at your family history as well as your projected income for the foreseeable future. These factors can help determine the extent of coverage you choose to buy for your family. If you find a company you like, you may want to assess if this company is one you can grow with.

Health Management Organization (HMO) : If you are part of an HMO, you use only services offered within the approved system of doctors and providers. Anything outside will cost.

Long-Term Factors of Signing On

There are mostly pros to getting health insurance. Instead, if you choose to wait, you are at risk for developing a condition that will preclude you from being eligible for certain plans. Thus, the sooner you have a good insurance plan, the better, because then you will be covered if anything unexpected comes up. Cons to health insurance could be overpaying for coverage you don't need, or not paying enough and then needing more benefits. Although you can never predict the future, you should evaluate your current health condition and expectations for the future.

Network : Your health care plan network is the system of approved doctors, pharmacies, and providers. Depending on the plan, if you go out of network you may have a higher co-pay, or no benefits at all. Each plan is different and will specify what is allowed.

Point of Service (POS) : This type of plan combines HMO benefits with a preferred provider organization (see below) and allow members to choose different levels, in-network and out-of-network.

Preferred Provider Organization (PPO) : This approach tries to maintain a variety of providers as well as cost incentives for working with preferred providers, but with the opportunity to go out-of-network.

We would be adding on to the list of terminology found in health insurance policies. If are unable to found a health insurance term, please email us at url@healthinsurancematters.com and we will add it to this list. Please support the spread of health insurance knowledge.

Health Insurance Nexus | US : The US Health Insurance Resource, conceptualized in Dec, 2004, is an online portal which provides up-to-date, pertinent information about health insurance in US. Copyright @2005 Honlyn Limited All Rights Reserved

In no event shall Health Insurance Matters be liable to anyone for any inaccuracies, errors or omissions with respect to the information for any damage arising therefrom or occasioned thereby, or for the results obtained from the use of the information. By accessing this site , you are agreeing to the terms of use .