We’ve translated a few of the confusing terms used in health insurance to help you better comprehend your coverage under health insurance. You should keep these health insurance terms in mind to refer to them in the future.
Coinsurance: Coinsurance refers to the portion of healthcare services you pay after you have met your deductible (if one is in place). In the example, if your bill is $100 with a coinsurance of 20%, you’ll be responsible for paying $20 for medical care if you’ve already reached your deductible.
Copay: A predetermined amount you might have to cover a health-related service or. For instance, the health insurance plan you have might require a copay of 15 dollars to protect an appointment or prescription. After that, the program will pay for the rest of the cost.
Deductible: It’s the amount you’ll have to spend out of cash before your health insurance comes in and covers your medical care.
The Essential Health Benefits: A collection of medical services must be covered by insurance plans part of the Health Insurance Marketplace. The services covered include emergency care such as hospitalization, maternity, and newborn treatment, mental health, prescription medications, preventative and wellness services, pediatric services, and much more.
In-Network: A network of hospitals, doctors, and other health providers that the health insurance plan has partnered with to offer medical care to plan members. They are also known as “network service providers.” You can determine whether a service is part of your network by checking your healthcare insurance coverage.
Out-of-Network: Health care providers who are not affiliated with a health insurance company and do not offer services to the plan’s members. You may have spent more money on the benefits of providers outside of the network.
Out-of-Pocket Expense: It is the price you spend on health care services. The cost out of pocket could be your Deductible, Coinsurance, and copays.
Maximum Out-of-Pocket Cost: The amount you’ll be able to pay during a policy (usually one year) before the date your plan begins to cover all of the Essential Health Benefits you receive. The maximum cost out of pocket for 2016 should not be more significant than $6,850 in an individual plan or $13,700 for family plans. This amount must include Deductibles, Coinsurance, and Copayments; however, it is not a typical way to include premiums towards your out-of-pocket maximum.
Premium: The monthly premium is the amount you’ll be required to pay your insurance provider to cover your health insurance. Usually, these payments take place monthly, quarterly, or annually.
Preventive Care: Health-related services aim to keep your body healthy before becoming sick. They include regular check-ups and counseling sessions for screening tests and vaccinations. The plans must provide these services for free when doctors in-network offer the services. It means that they cannot contact Coinsurance, regardless of whether you’re not able to meet the deductible you have for this entire year.
Provider: The establishment or individual you go to to get health care services. Examples include hospitals, doctors’ pharmacies, hospitals, and many other places. Make sure to check with your health insurance company to determine if a service is in-network or out-of-network.
Provider Network: It refers to the network of hospitals, doctors, and other health care providers who collaborate with your health insurance company to provide health care services. The kind of plan you are on will influence the size of the provider network.
Contact Ottawa Life Insurance at (613) 454-1424 or email us at info@ottawa-lifeinsurance.ca to understand more terms.
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