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Health Insurance Essay

1236 words - 5 pages

Health
Insurance
Basics:
Key Words and
Phrases You Need
to Know

Shopping for insurance can be confusing, but
the new health care law makes it easier to
understand. This simple guide will help you
make smarter choices for you and your family.

KEY WORDS AND PHRASES

What You Pay
There are different costs associated with health insurance.
When choosing a plan, it is important to take into account
all of the costs for each plan.

Premium
The money you pay the insurance company
to buy the plan. You usually pay this
monthly or every pay period. If you get
coverage through your job, your employer
may also pay a part of the premium.

Deductible

$

The amount you ...view middle of the document...

Many
preventive services now do not require copays or
co-insurance.

Out-of-Pocket Limit
The most you will have to pay each year
for care covered by your plan. Once
you hit that limit, your insurance starts
paying for all of your covered costs.

KEY WORDS AND PHRASES

Getting the
Health Care You Need
Different plans have different rules about how you can get
the health care you need and still have your plan cover your
medical costs. You should know these rules to make sure
you get the benefit of your plan’s coverage and save money.

Provider Network
The doctors and other health care providers who have
agreed to work with your health insurance company.
Different kinds of plans have different rules about their
provider networks. Most will require higher out-of-pocket
costs if you go outside their network, and some won’t
cover any care outside of their network at all.
There are two types of provider networks:
„„

Preferred Provider Organizations (PPOs) and Point of
Service (POS) plans

„„

Health Maintenance Organizations (HMOs) and
Exclusive Provider Organizations (EPOs)

Preferred Provider
Organizations (PPOs) and
Point of Service (POS) Plans
Plans that usually cover some of the
cost of services you get outside their
preferred provider network. However,
you will probably have to pay higher deductibles and/or
copays or co-insurance if you go outside of network.

+

KEY WORDS AND PHRASES

Getting the
Health Care You Need
Health Maintenance
Organizations (HMOs) and
Exclusive Provider
Organizations (EPOs)
Plans that usually cover only care
that is provided within their network. They also often
require you to pick a “primary care doctor” to go to for
your regular visits (like a family physician, an internist,
or a pediatrician) who has to give you permission, or a
“referral,” to see a specialist.

Preauthorization
A requirement that certain services, treatments,
medications, and equipment be approved in advance
by the insurance company, except in emergencies.
While getting preauthorization doesn’t guarantee that
the service will be covered, not getting it when you
need to will likely cause you to pay more than you
could have if you had gotten preauthorization.

TIP: To get the most out of your insurance, know

your plan’s rules. To save the most money, try to stay in
its preferred provider network (if it has one) and get the
proper referrals and preauthorizations if you need them.

THINGS TO REMEMBER

Picking the Right Plan
To make the best health insurance choice for you and
your family, you can’t look just at the “sticker price”—the
premium. Consider all the...

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