Health Insurance 101

Q: What is Health Insurance?

A health insurance policy is a necessity to everyone because it provides coverage in case of unforeseen medical expenses, such as hospitalization costs and prescription drugs. It provides you the access to the care when you need it.

Q: What is a deductible?

The health insurance deductible is the amount of money you pay for healthcare services covered under your plan before coverage begins. As a general rule, the lower your premium, the higher your deductible will be.

There are many factors to consider when choosing your coverage and it's important that you have help customizing these benefits based on what best fits your needs.

Q: What is coinsurance?

Coinsurance is the amount you pay AFTER your deductible has been met. For example, let’s say you have a surgery that costs $10,000. If your deductible is $5,000 and you have 80/20 coinsurance, you will pay the first $5,000 and then you will pay 20% coinsurance of what is left over until you reach your max-out-of-pocket.

Q: What is a max-out-of-pocket?

The out-of-pocket maximum is the cap on what a policyholder is responsible for paying each year for covered expenses.

When a policyholder meets the out-of-pocket maximum, the insurance company pays 100% of all allowed healthcare expenses. Having a plan with an out-of-pocket maximum protects the insured against catastrophic financial losses.

Q: What are the different types of health insurance networks?

A network can be made up of doctors, hospitals and other health care providers and facilities that have agreed to offer negotiated rates for services to insureds of certain medical insurance plans.

A PPO (Preferred Provider Organization) plan is designed to give you more flexibility in choosing which health care providers you see.. PPOs have a network of providers they prefer that you use, but they'll still pay for out-of-network care.

EPOs (Exclusive Provider Organization) got that name because they have a network of providers they use exclusively.

HMOs (Health Maintenance Organization) require primary care provider (PCP) referrals and won't pay for care received out-of-network except in emergencies. But they tend to have lower monthly premiums than plans that offer similar benefits but come with fewer network restrictions.

A POS (Point of Service) plan is a combination of an HMO and PPO. Members need a referral to see a specialist and will have some coverage for out-of-network care (often with a higher copay).

Q: Do I Need Dental & Vision Coverage?

Most health insurance providers offer affordable dental and vision plans that will increase your monthly premium by a minimal amount. You may have the opportunity to choose from several types of dental or vision coverage that offer varying levels of service. You may be charged a co-payment for the specific services you receive as well as a premium and a deductible. Compare the costs and benefits of several plans to find coverage that fits your needs as well as your budget.

If you have growing children, having dental and vision insurance is especially important. Children need regular dental cleanings and exams to keep their teeth healthy and prevent complications from tooth decay and cavities. Young children and teens may have visual changes that need to be evaluated by a professional and corrected by glasses or contacts.

To protect your family’s health and safety and give your kids the care they need for success, invest in competitively priced dental and vision coverage. Most providers will allow you to add dental or vision plans to your main policy at any time. Even if you’ve been covered by a health insurance plan for years, it’s never too late to extend your benefits to protect your teeth, gums and eyes.

Q: What is an HSA Plan?

A health savings account, or HSA, is a medical savings account available to taxpayers who are enrolled in a High Deductible Health Plan. An HSA allows people with high-deductible health plans (HDHPs) to save money for medical expenses. Contributions are made to the account by your or your employer and are limited to a maximum amount each year. The funds in your HSA account can be invested over time and can be used to pay for qualified medical expenses. The money that you put into your HSA is tax deductible, grows tax free and certain withdraws are tax free if they are for qualified medical expenses. In addition to doctor’s visits and prescription drugs, over-the counter drugs and other health-related items may also qualify.

Q: How do I view my policy documents?

Most insurance companies offer a client online portal via their website. There you can typically find policy details, payment information, claims documents, etc. Reach out to your carrier for information on how to access your portal.