Health Insurance

What is a health insurance deductible?

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This is the amount you will have to pay before your insurance company will start covering the costs. Not all services will require you to meet the deductible before being eligible for coverage.

 

Note, higher deductible insurance plans will generally cost less than lower deductible insurance plans. Weigh the difference and be sure to find the best deductible for your health & budget.

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What is a health insurance copayment?

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A plan that has copayments will have a set fee for services covered by a copay. An example of this is if your plan covers doctor visits but you need to pay a copayment of $50 for the visit. Verify your coverage with your insurance carrier before getting medical attention.

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What is a Special Enrollment Period (SEP)?

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Special Enrollment Period (SEP) is a time outside the yearly Open Enrollment Period (OEP) when you can sign up for health insurance. You qualify for a Special Enrollment Period if you’ve had certain life events, including losing health coverage, moving, getting married, having a baby, or adopting a child.

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Special Enrollment Periods only give so much time to take action. If you miss your Special Enrollment Period window, you may have to wait until the next Open Enrollment Period to apply.

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Let’s face it, medical treatments aren’t cheap. Without health insurance coverage you could end up paying off medical bills for the rest of your life.

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Major Types of Health Coverage

There are basically four major types of health insurance policies for Florida residents to choose from EPO, HMO, POS, and PPO.

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These health insurance plans help cover your medical, surgical, and hospital expenses. They may even cover dental expenses, mental health services, and prescription drugs, depending on the coverage you choose.

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• What Is An Exclusive Provider Organization (EPO): A managed care plan where services are covered only if you use doctors, specialists, or hospitals in the plan’s network (except in an emergency).

 

• What Is A Health Maintenance Organization (HMO): A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally won’t cover out-of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage. HMOs often provide integrated care and focus on prevention and wellness.

 

• What Is Point of Service (POS): A type of plan where you pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network. POS plans require you to get a referral from your primary care doctor in order to see a specialist.

 

• What Is A Preferred Provider Organization (PPO): A type of health plan where you pay less if you use providers in the plan’s network. You can use doctors, hospitals, and providers outside of the network without a referral for an additional cost.

 

Common Health Insurance Terms

When discussing health insurance with your agent, it helps to understand some of the common terms you’ll run into. Below you’ll find definitions to some of the most common health insurance terms.

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• What Is A Deductible: The amount of money you pay toward medical bills before your insurance coverage begins.

 

• What Is A Co-pay: A specified amount of money you pay upfront for doctor visits and prescription refills.

 

• What Is Co-Insurance: percentage of medical bills you pay after meeting the deductible.

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• What Is The Maximum Out-Of-Pocket: This means how much you will pay per year for covered services. After you have paid this amount in deductibles, copays & co-insurance in the policy year medical services are typically covered at 100% for the rest of they policy year.

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