We think you have liked this presentation. If you wish to download it, please recommend it to your friends in any social system. Share buttons are a little bit lower. Thank you!
Presentation is loading. Please wait.
Published byBrett Palmer
Modified over 8 years ago
© 2009 Corporate Executive Board, All Rights Reserved. Health Plan Dictionary How to Understand Your Plan and Make Cost- Effective Choices
© 2009 Corporate Executive Board, All Rights Reserved. 1.Premium A premium is a fee paid simply for coverage of medical benefits for a period of time. Premiums can be paid by employers or employees, but they are frequently shared across both. Tip: Plans with higher premiums typically have lower deductibles, so if you use health care services often, so if you use health care services often, you may want to consider a plan with higher premiums to reduce your out-of-pocket costs as you use services across the year. 2. Deductible A deductible is a set amount you must pay for health care expenses before insurance begins to cover all or a portion of the total costs. Often, insurance plans are based on yearly deductible amounts. Tip: Plans with higher deductibles typically have lower premiums, so if you use services infrequently, you may want to consider a plan with a high deductible, so your premium costs will be lower. Dictionary of Health Insurance Components
© 2009 Corporate Executive Board, All Rights Reserved. Dictionary of Health Insurance Components (cont.) 3.Co-pay A co-pay (or co-payment) is a set fee that you pay for health care services, in addition to what the insurance company covers. For example, some plans require a $25 co-pay for an office visit to a primary care physician. Depending on your plan, you may have co-pays or co- insurance. Tips: If you want your health care costs to be predictable, consider a plan with co-pays instead of co- insurance if one is available. Also, plans usually have lower co-pays for primary care physician visits and generic prescriptions as compared to specialist visits and name brand drugs.
© 2009 Corporate Executive Board, All Rights Reserved. Dictionary of Health Insurance Components (cont.) 4. Co-insurance Co-insurance is a variable fee you pay for health care services, which is usually calculated as a percentage of the total service cost. For example, your coinsurance may be 20% of the cost for a primary care visit, with the insurance plan paying the remaining 80%. Tips: Plans with coinsurance often have lower premiums, and depending on the service, coinsurance may not be more than a co-pay. To help manage costs, ask about and compare the cost of health care services before selecting them.
© 2009 Corporate Executive Board, All Rights Reserved. 5.Network A network is a group of doctors, hospitals, and other care providers contracted to provide services to insurance companies' customers for less than usual fees. Provider networks can cover a large geographic market or a wide range of health care services. In-Network providers or health care facilities are part of a health plan's network. Insured individuals usually pay less for using an in-network provider. Out-of-Network providers are non-participants in an insurance plan's network. Depending on an individual's plan, expenses for services provided by out-of-network health professionals may not be covered at all or covered only in part by your plan. Tip: Before switching plans, ensure that any providers that are critical to your care are located in- network to avoid out-of-network charges. Dictionary of Health Insurance Components (cont.)
© 2009 Corporate Executive Board, All Rights Reserved. 7.Claim A claim is request to an insurance company to pay for your health care services. In some cases, your care provider, such as a doctor's office, submits a claim on your behalf. In some cases, however, you may submit a claim directly to the insurance company. Tip: If you don’t understand a health care bill or believe your claim was not processed correctly, contact your provider or your health insurance company. Dictionary of Health Insurance Components (cont.) 6.Out-of-Pocket Maximum An out-of-pocket maximum is a predetermined limit to the amount of money that you must pay before the health insurance company pays 100% of an individual's health care expenses. Tip: If you are managing a critical condition or anticipate high health care costs associated with treatments, surgeries, or extended hospital stays, consider a plan with a lower out-of-pocket maximum.
Understanding your Accident & Sickness Health Insurance Coverage.
Deductibles & Maximum out of pockets Part of the Medical Plan 11.
2011 HEALTH INSURANCE CHANGES. Why change the Health Plan? State revenues for Millard Public schools are projected to decline significantly over the next.
The New Fully Insured HRA “Two Card” Health Insurance Program Works And High Deductible Major Medical Plan.
How To Use Your New “Two Card” Health Insurance Program And High Deductible Major Medical Plan SLPS DCPP Insured by Standard Life and Accident.
What is Health Insurance? Health insurance is a contract between a consumer and an insurance company. Health coverage helps people pay for medical costs.
Nicholls State University Human Resources Annual Enrollment Overview.
PAYMENT METHODS: Managed Care and Indemnity Plans
2010 Plan Information State Personnel Department Enroll online Nov. 2 through Nov. 23, 2009 at noon (EST)
Types of Health Plans. The practice of medicine is complicated and expensive Medical insurance often covers routine care, such as annual physicals, and.
Employee Health Benefits Indiana State Personnel Department Benefits Division.
Indemnity or Fee-for-Service coverage- -allow you go to the doctor of your choice and pay for services at the time of the visit. -The amount that your.
+ HEALTH INSURANCE TERMS TO KNOW. + Premiums A premium is a fixed dollar amount that will stay the same each month whether you use the doctor a lot or.
Dynamics of Care in Society Health Care Economics 1.
Y0096_MRK_IL_MAEDPPT15. Today’s Topics Medicare Basics Medicare Advantage (MA) Plans Eligibility and Enrollment periods 2.
Mr. Woodington’s Money Management II. Review of Basic Insurance Concepts Employer Provided Health Insurance Overview How HMOs Work How PPOs Work.
Health Insurance Law and You Mr. Blais. Managed Care Plans These involve arrangements between the insurance companies and a certain network of health-care.
1 Health Insurance Briefing 22 July 2010 CHANGES IN THE HEALTH INSURANCE PROGRAMMES
Understanding and Using Your Coverage
© 2023 SlidePlayer.com Inc. All rights reserved.