Health Insurance Terms and Options

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Information about Health Insurance Terms and Options

Published on August 19, 2008

Author: RAMBHQ


Health Insurance OptionsSmall Group (2+ Employees)One Man GroupIndividual Health InsuranceShort Term Health InsuranceAssociation Health : Health Insurance OptionsSmall Group (2+ Employees)One Man GroupIndividual Health InsuranceShort Term Health InsuranceAssociation Health Insurance Terms : Insurance Terms Co-Pay – The dollar amount a managed care patient pays when services are received. Co-Insurance - The portion of covered expenses that must be paid by the policyholder in addition to the deductible. Deductible - The amount a person must pay before the insurance company begins to pay its portion of claims. Insurance Terms : Insurance Terms Out-of-Pocket Maximum - A limit on all of the insured's out-of-pocket expenses (deductibles and coinsurance) for treatment of illness or injury. When the maximum is reached, the insurance company will begin covering 100 percent of eligible charges. Health Maintenance Organization (HMO) - HMOs require you to select a primary care physician, generally a family practitioner or pediatrician, who is part of their network. file. A referral from your primary care physician is required to see a specialist other than an OB/GYN. Insurance Terms : Insurance Terms HMO (Open Access)- HMO OA’s require you to select a primary care physician, however you are not required to get a referral to go to other Doctors in the Network. Preferred provider organization (PPO) - The enrollees may go outside the network, but would incur larger costs in the form of higher deductibles and coinsurance rates, or non-discounted charges from the providers. Point-of-service (POS) plan – HMO/PPO hybrid; sometimes referred to as an "open-ended" HMO. POS plans resemble HMOs for in-network services. Services received outside of the network are usually provider reimbursement based on a fee schedule or usual, customary and reasonable charges). Small Group Insurance : Small Group Insurance Issued 12 months a year. Guaranteed Issue Must have at least two W-2 employees on Tax Form UTC-6 Employer required to pay 50% of Employee portion of Insurance 75% of Eligible Employees participate 1099 Independent Contractors may participate One Man Group : One Man Group Offered Only Once a Year in August, issued with an October 1st Start Date Guaranteed Issue All Pre-existing Conditions covered after 12 months unless prior continuous coverage exist except for pregnancy Considered Insurance of Last Resort due to pricing Individual Health Insurance : Individual Health Insurance NOT Guaranteed Issue Insurance of Choice for those who qualify Pricing Often More favorable than Group Doesn’t Offer Maternity Health Saving Account Options (HSA) Short Term Health Insurance : Short Term Health Insurance Simplified Issue Indemnity Plan with Network Available Issue for 1,3,6 or 12 months with renewals a for up to 3 years No Pre-existing coverage Favorable Pricing Association Health Insurance : Association Health Insurance Simplified Issue Limited Benefit Plan No Deductible or Co-Insurance Defined Benefit with Office Visits, Hospital, Surgical and Pharmacy Coverage Network Available for Discounts Add High Deductible Option to complete a comprehensive coverage Low Cost

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