Tips To Recognize Health Insurance Terms

Written By: April Kerr on September 5, 2009 No Comment

It doesn’t matter who you are, you probably have, or have had, health insurance. And, chances are that you’ve also seen all of the medical and insurance jargon that is downright confusing to the majority of readers. But if you know what these terms mean, then you can easily get the right policy and coverage for you. So, here are eight of the most common, essential health insurance terms that you need to know:

Premium: This is the amount that you or your employer (or sponsor) has to pay every month for the health insurance to cover yourself or your family.

Deductible: This is the amount that you have to pay from your own pocket before the insurance will take care of their part.

Copayment – many health insurance plans have their insureds pay a copayment for services rendered for medical care. Normally, these copays are under $50, but for specialized services, they can be higher. The insurance will then pay the rest.

Coinsurance – this is when you have more than one type of health insurance. Coinsurance means that your services will be completely covered, not just part. Many elderly people have two or more types of insurance to help cover what Medicare will not and cover any deductibles or copayments so that they can easily plan their expenses each month.

Coverage limits – some health insurance will place a cap on how much can be spent on specific things, such as physicals each year and so forth. Make sure that you know exactly what the limits are on basic services and any other service that you feel you might use a lot.

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 means that before you can go to a specific medical professional, you have to have authorization from your health insurance company. This normally happens when you need to go to a specialist, such as an OB/GYN, a Physical Therapist, or Surgeon. This helps your health insurance company ensure that you see a medical professional that is in-network that they can work with.

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.

As you can see, these are only eight health insurance terms that you should be aware of and know. Of course, there are thousands of other terms that you need to be familiar with so that you can fully understand everything that is in your health insurance policy. When you know and understand everything about your policy, you are less likely to have problems.

Dawn Enstruthe writes for website DS Health Insurance which info on topics like low income dental insurance at cheap prices and very dental insurance for seniors.