Health insurance is a type of insurance that covers personal medical care including surgical bills. Health insurance plan has few types and each plan has different rules and policies, for example, reimbursing what you had spent for medical bills or directly paying your medical bills.
For those who are looking for health insurance plan, it is much better if you know the health insurance terminologies at least the basic terms that you will often see in brochures.
Health insurance terminologies
- Deductible is the requiring amount you have to pay per year before the insurers can pay the cost of your medical expenses. Depending on the insurers’ rules and policies, some insurers’ may pay the cost of particular expenses such as medical check-up even though you haven’t pay full of your deductible.
- Coinsurance is the charge fee you have to pay for medical expenses after you complete the deductible payment.
- Co-pay is the amount you have to pay after receiving particular type of medical treatment.
- Denial of claim is the situation when the insurers’ won’t pay your claim for certain medical treatment because it is not included in the agreement.
- Not-covered, limitations, or exclusions are certain medical treatment that aren’t covered in the insurance plan.
- Health saving account is a saving account just for paying health care expenses.
- Formulary is the list medicines that included in the insurance plan.
- Out-of-network is medical services that are not included in the insurance plan’s network or providers.
- Pre-existing condition is your health condition before applying health insurance.
- Premium is a regular set fee you have to pay for the insurance plan.
Health insurance plan that offered by insurance companies have few types and each type has level of benefits from platinum to bronze. Platinum is the most expensive plan and the bronze is the least one. The deductible amount are varied depending on the insurance plan you choose. The higher level you choose, the less amount you will pay for your deductible. Here are the summary of health insurance plan based on level of benefits.
- Platinum, in this level the insurers would help paying 90% of your medical expenses, so you only have to pay 10% of the expenses.
- Gold, the insurers would help paying 80% of your medical expenses and you have to pay the remaining twenty percent.
- Silver, the insurers would help paying 70% of your medical expenses and you have to pay the remaining thirty percent.
- Bronze, the insurers would help paying 60% of your medical expenses and you have to pay the remaining forty percent.
- Catastrophic, the insurers would help paying less than 60% of total medical expenses, but the insurers would cover all the costs of the first three visiting times to primary care and preventive care whether you have completed your deductible or not.