When looking for the best health insurance for individuals - if you don't know the jargon you're likely to wind up over-paying or buying the wrong coverage. Below is an essential guide to some of the more important individual health insurance terms for health insurance comparison. Make sure you are familiar with them before shopping for individual health insurance plans.
Health Insurance Terminology:
Ancillary Care - Ancillary simply means "additional" or "related" or "extra". It applies to policies that not only have basic coverage but have additional (ancillary) coverage for prescription drugs or eye care, for example.
Cap: This is the maximum amount of the insurance company will pay over a lifetime.
Claim form: In order to receive payment for services rendered, you or your health care provider must complete this form and send it to the insurance company.
Cobra - The "Consolidated Omnibus Budget Reconciliation Act" is a Federal law that requires companies to offer extended health care coverage to terminated employees for a period of time. This coverage is typically paid for by the ex-employee but at group rates.
Coinsurance: This is the percentage of the health care bill you have to pay after the deductible.
Co-payment - This is a health insurance term for what individuals pays for a visit or procedure. After your co-payment and deductible the insurance company covers the rest of the bill.
Covered expenses: These expenses will be paid for by the insurance company. Remember, not all expenses are covered by the health plan.
Customary fee: This is the amount the health care provider charges for a service. It can also be called a usual and customary fee.
Deductible: This is an expense that you need to pay before the insurance plan begins paying.
Exclusion: Services that are not covered by the insurance company.
Fee for Service - This is the type of health Insurance that allows you to select any Doctor and pays for some agreed percentage of "reasonable and customary" fees. You then end up paying the difference.
H,M.O. - "HMOs" are created to deliver complete health coverage for a predetermined fee. Although insurance price quotes for these organizations generally call for you to use their MD's and hospitals thus restricting your selection.
Life and Health - This is the part of the insurance industry that covers life and health insurance for individuals as opposed to property and casualty.
In Network: In order to avoid higher costs you can choose from a list of health providers selected by your insurance company.
Maximum out of pocket expenses: This is the most you will ever have to pay during one year of deductibles and coinsurance.
Out of network: These are licensed health care providers who are not on the in network list.
P.P.O. - "Preferred Provider Organizations" are networks of doctors who charge on a fee for service basis but typically at a discount pre-negotiated by the insurance company. Thus insurance companies will usually pay a larger share of your bill if you go to one of their "preferred providers."
Premium: This is the annual cost of the health insurance coverage for individuals or families.
Third Party Player: Anyone other than yourself who will pay for your care.
Where to Find Health Insurance for Individuals
Understanding health insurance terminology is the best preparation for obtaining health insurance for individuals that makes sense and that meets your needs. You are able to ask the right questions of agents and insurance companies giving you quotes, and you will be able to compare apples to apples when evaluating multiple insurance quotes and policies. Now that you are ready to request quotes you will find companies ready to quote insurance rates right online.
When looking for the best health insurance for individuals - if you don't know the jargon you're likely to wind up over-paying or buying the wrong coverage. Above is an essential guide to some of the more important individual health insurance terms for health insurance comparison. Make sure you are familiar with them before shopping for individual health insurance plans.
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