Open Enrollment - Page 15 - Important insurance terminology you should know

Open Enrollment
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Important insurance terminology you should know
Be familiar with your insurance coverage plan and policies. For example, if you are having surgery, does your doctor and physician participate with your insurance company? A good source of information is your member guide, most of which can be found online. In addition, educate yourself on whether or not you are required to go to a particular place for a service, i.e. lab work or radiology. Be familiar with your deductible, co-insurance, co-pay or out-of-pocket. What do those terms mean?

Out-of-pocket maximum/limit.
The most you have to pay for covered services in a plan year. After you spend this amount of deductibles, co-payments, and coinsurance, your health plan pays 100 percent of the costs of covered benefits. The out-of-pocket limit doesn’t include your monthly premiums.

A specific amount of money that the insured must pay before an insurance company will pay a claim.

A co-pay is a fixed amount you pay for a health care service, usually paid upon receiving the service. You may have a copay before you’ve finished paying toward your deductible. You may also have a copay after you pay your deductible, and when you owe co-insurance.

The percentage of costs of a covered health care service you pay (20 percent for example) after you’ve paid your deductible. For example, if your health insurance plan’s allowed amount for an office visit is $100 and your co-insurance is 20 percent, if you’ve paid your deductible you will need to pay 20 percent of $100, or $20. •

Courtesy of University of Maryland St. Joseph’s Medical Center