Recreation Business Life & Health Title & Notary Home Auto Get A Quote Home Page
  Insuring Your Future Today with the Best Coverage at the Right Price for You and Your Needs Because It’s Always Something



Health insurance seems to have its own language and it can be confusing when it comes time to either compare plans when choosing your coverage or when reading the information in the summary of benefits book or on an explanation of benefits form for a service that you have had.  Luckily, there are easy examples and definitions that can clear the way for a greater understanding of insurance terms.

The top three most questioned terms:

  1. DEDUCTIBLE:  The initial amount that you are responsible to pay for certain covered services before your insurance pays it’s part.  For example, if you have an annual deductible of $1,000 and your benefits plan says that your surgery coinsurance is 20% after your deductible is satisfied; you pay the first $1,000 before your insurance pays their 80% of the remainder of the cost of  your surgery.  Some plans have co-pays for doctor visits but the full allowed amount must be paid and the deductible satisfied before they take effect.  Certain plans may have a deductible for prescriptions as well.  The deductible does not include the amount that you pay for your premium, only the amount that  you pay for healthcare services.
  2. COINSURANCE:  A coinsurance is your share of the cost of a covered service.  In the above example, if your surgery costs $10,000, you would pay your deductible of $1,000, and 20% of the remaining balance, or $1,800, and the plan would pay $7,200.
  3. CO-PAYS:  A fixed amount that you pay for certain services.  If you look at your Member ID card (the one you show at the doctor’s office), you will see what your co-pay will be.  For example, mine lists my office visit co-payment as $20 and my specialist office visit co-pay as $40.  That means that when I go to see my family doctor if I have a cold, i will pay $20 for the service, but if I have to see an Ear-Nose-Throat Specialist for tonsillitis, I would pay $40.  I also have an $8 co-pay for generic prescription drugs, after I satisfy my deductible, of course.

Hopefully, this clears up some of the sometimes puzzling terms associated with your health insurance.  Look to future posts, where I will delve into some more definitions and examples that we can all understand!

 

If you have any questions about specific terms or phrases that you would like an explanation for, please call a member of our health and life team at (814) 226-5000 or email me at tracey.moon@smathersagency.com.

Posted 10:39 AM  View Comments

Share |


No Comments


Post a Comment
Name
Required
E-Mail
Required (Not Displayed)
Comment
Required


All comments are moderated and stripped of HTML.
Submission Validation
Required
CAPTCHA
Change the CAPTCHA codeSpeak the CAPTCHA code
 
Enter the Validation Code from above.
NOTICE: This blog and website are made available by the publisher for educational and informational purposes only. It is not be used as a substitute for competent insurance, legal, or tax advice from a licensed professional in your state. By using this blog site you understand that there is no broker client relationship between you and the blog and website publisher.
Blog Archive


View Mobile Version

        Turning 65 soon??
Talk to one of our Health Insurance
specialists today about how to
prepare for Medicare.  Contact Us 

Title & Notary Services now offered
in two locations:
Clarion and Butler.


400 Main Street | Clarion, PA 16214 | Phone: (814) 226-5000 | Toll-Free: (800) 243-2625 | Fax: (814) 226-5731
 
            Home | About | Services | Contact

About Us Services Contact Us