In many cases when searching for a health plan or reading through a policy you already have purchased, some specific terms and provisions may sound quite complex to understand. And respectively many questions arise concerning the meaning of one provision or another. Knowing the exact meaning of what is stated in your policy is important, because you may misinterpret the conditions provided with your plan and lose quite a hefty amount of money in the end. In order to avoid having problems with understanding some specific terms in your policy here is a short glossary of the most common entries people get confused about. Learn what is what and it will be a lot easier for you to operate and talk to your insurance agent or broker when the time comes.
Deductible
Simply put, deductible is the amount of money you have to pay out of own pocket before being able to get any benefits from your insurance policy. In most cases, this amount has a one year period and will refresh with the renewal of your policy. Some medical services like doctor consultations can be received without meeting the deductible first, but it is recommended to learn the exact list before applying for any services. In case you have other family members included in your policy there are separate individual deductibles and whole family amounts.
Co-insurance
Co-insurance is somewhat similar to deductibles as it is the amount of money you have to pay before getting the benefits of the policy. It is often applied when the deductible isn’t required, for example when visiting a doctor.
Co-payments
This is the same as co-insurance and can be used to substitute the term.
Out-of-Pocket
As the name suggests it’s the amount of money you will have to pay before taking benefit of the policy coverage, i.e. all deductibles and co-payments combined. This amount is usually specified over a one year period when you renew the policy and doesn’t include premiums.
Lifetime maximum
This stands for the maximum sum of money that the policy will pay over the whole lifetime of its owner. There’s usually a difference between individual lifetime maximum and that of the whole family.
Exclusions
Any conditions and services your policy coverage does not include.
Pre-existing conditions
Any health issues and conditions present with the policy holder before obtaining the actual policy. Some insurance companies cover pre-existing conditions, some others don’t. In some cases the policy will cover pre-existing conditions only after some time the policy has taken effect. So make sure to learn what are the conditions of your insurer if you have a health problem, especially if you have cheap health insurance.
Waiting period
The period of time after purchasing the policy and before the policy takes effect and provides coverage.
Coordination of benefits
In case the insured person is covered by two or more policies (personal and that of a spouses, or employer-provided group plan) no insurance company will make it possible to obtain double benefits when covering a claim. No matter whether you have cheap health insurance provided by your employer or a costly personal plan, the insurance company will make sure that the entire coverage amount is delivered in portions from all the policies you are insured with.
Grace period
The period of time for paying the premium after the due date and prior to the policy’s cancellation.
