There are plenty of medical terms that govern health insurance that everyone has heard – yet they may not really know. Some terms are easy to understand, while others are downright odd. Before you start to read too much into your health insurance policy, there are some main medical and insurance terms that you need to be aware of. Here are 8 that you should know so you can properly understand your insurance:
Premium – for many people, this is what your employer, or sponsor, will pay each month for your health insurance. Sometimes, individuals pay this amount to their employer or directly to the health insurance company. This, in turn, covers you under their insurance.
Deductible – some health insurance policies have a deductible that you have to meet before they will cover services, which is basically a set amount that comes out of your pocket.
Copayment – some health insurance plans have you pay a copayment, or part of the bill for that service. This is usually done before the health insurance will pay for the remainder of their services. Usually, this is pretty small, such as under $60.
Coinsurance – many people have this, especially seniors that are on Medicare. This just means that you have one main health insurance plan and then another, smaller plan (coinsurance) that covers the remainder of the bill. Many people that are on fixed incomes have coinsurance so that they aren’t stuck with massive unexpected expenses.
Coverage Limits: There are some health insurance policies that will only pay for a specific set amount of different types of coverage. For example, they may only pay up to $1000 a year on basic physicals for your entire family. This is one area where you need to check your health insurance plan well so you aren’t caught with payments that you thought we covered.
In-Network – this is the term that is used to cover the doctors and other medical professionals that accept that specific health insurance. When you sign up for health insurance, you will normally get a book with a list of “in-network” providers that have already made an agreement with the health insurance company.
Prior Authorization – this basically means that you need to get approval from your health insurance or primary care provider to go and see a specialist, such as a Physical Therapist, an OB/GYN, or surgeons. This also helps to keep you in the network of their providers.
Capitation – this is a term that many people aren’t familiar with. It basically is the amount that the health insurance company will pay a specific medical professional to ensure that they will see anyone that is covered under their health plan. This is how your health insurance comes up with their in-network lists.
Now, these aren’t the only medical and insurance terms that you should be aware of. There are literally thousands of different terms that you should at least know basically what they mean so that you aren’t blindsided with any out of pocket costs when it comes to health insurance.
Dawn Enstruthe writes for website DS Health Insurance which info on topics like dental insurance for those with low incomes and dental insurance for seniors.
