Terms to know when shopping for medical insurance.
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Co-insurance – the percentage of your bill that you are responsible for, this occurs after the deductible is met but before you reach your max out of pocket.
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Co-pay – a flat dollar amount that you pay a provider for services, for example a $25 co-pay for a doctor’s visit.
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Deductible – the amount you must pay for services before your insurance starts paying. Check your plan carefully the deductible does not apply to all services.
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HMO – a more restrictive but often lower cost health plan. HMO’s save money by limiting the providers in their network and restricting coverage to only network providers except in medical emergencies.
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HSA – a health savings account is a way to save money, at a tax savings, for use in paying medical expenses.
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Maximum out of Pocket – the total including amount you could have to pay, including deductible, in a calender year for all covered services. This does not include your premium.
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Network – Doctors, hospitals, pharmacies, etc… contracted to provide services for an insurance carrier at a set price.
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PPO – a plan offering broader coverage than an HMO, often for a higher cost. They cover services both in and out of network, but you pay less using network providers.
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Provider – any medical facility or professional providing services to members.
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Referral – often used to control costs in an HMO a referral is a pre-authorization from your primary doctor to see a certain specialist or have tests done.