When dealing with a health insurance plan, whether a new one or the one you have already purchased, the specific language of its contents can be confusing for most people. All these provisions, coverage options and payments make little sense unless you are an insurance expert. And it’s not that rare that a person asks what does their policy provide even after having it for some time.
Don’t worry, we are here to help you. Below you will find the most commonly used health insurance terms you will find in any policy with brief and comprehensive explanation that will help you understand your insurance policy better.
Deductible is the sum of money the policy-holder has to pay out of pocket before the policy benefits will kick in. This amount is typically set on an early basis, meaning that a certain part or the whole deductible in the current year, this amount will be renewed in the next one. Certain services provided by the insurance policies such as physician visits are available free of deductible. If you have your family members included into your policy, there’s usually a separate distinction between individual and group deductible amounts.
The sum of money you have to pay on your own before your policy starts covering you in addition to the plan’s deductible. Certain plans will require only co-insurance payments for some types of services without requiring you to pay the deductible.
It’s a general term denoting all payments that you have to make on your account before the policy coverage kicks in. This usually refers to deductibles, co-payments and co-insurance. When speaking of annual out-of-pocket maximum this term refers to the overall costs of the insurance policy during the year minus the premiums.
This term refers to the maximum sum of money you can receive with your insurance policy in the course its entire duration period. Most health insurance plans have separate lifetime maximums for individual and group purposes so pay attention when reviewing the policy or getting health insurance quotes.
As you can guess, these are provisions that your health insurance plan won’t cover.
This refers to all health conditions that you were diagnosed with before purchasing the policy. Certain insurance companies will not cover such conditions, while other companies will. Learn about this option when you getting health insurance quotes especially if you have certain health problems you want to cover.
This is the period of time the policy-holder will have to wait before receiving any benefits from the insurance policy.
Coordination of Benefits
In case the policy-holder has source of coverage additional to the present policy the benefits received from all the policies will be coordinated in order to make sure that the person does not receive double coverage.
The period of time starting after the premium payment due date that the person is still able to pay without risking the policy to be void.