The challenge with health insurance is that we hear about it once a year during open enrollment, and the next time we use it we are either not feeling well, or checking out at the pharmacy or doctor’s office. You’ve heard about the following terms, now you’ll know what they mean:
Copay – a preset amount you pay for a covered health care service, such as a doctor visit or prescription. You pay the set amount, your health plan pays the rest.
Deductible – an annual amount you’ll pay before your health plan begins to pay for certain covered services.
Coinsurance – your share of the cost of covered health care services after the deductible has been met. Your health plan pays the rest of the covered charges.
Out-of-Pocket Maximum – the most you’ll pay before your health plan begins to pay 100% of covered medical services. In many cases, your deductible, coinsurance, and copays counts towards your total out-of-pocket maximum. Check your health plan for details.
In-Network – health care facilities, doctors, and pharmacies that have contracts with your health insurance plan to deliver services at a negotiated rate or discount. You will typically have lower out-of-pocket costs for services you receive in-network.
Out-of-Network – a health care facility, doctor, or pharmacy that does not have a contract with your health insurance plan. They typically don’t provide services at a discounted rate and you will have higher out-of-pocket costs.
Primary Care Provider – also known as a PCP, this is your personal health care provider who coordinates all of your medical care, from routine physicals to referring you to specialists. This physician gets to know you, your medical history, and your personal preferences, which can be very valuable.
Pre-certification – pre-certification is getting approval from your health insurance plan before receiving services such as hospital stays, advanced testing, or outpatient procedures. During this process, your health insurance plan reviews medical criteria to determine coverage under your health insurance plan.