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Answers To Common Insurance Questions: |
What is an individual health insurance plan? An individual and family health insurance plan is an insurance plan |
What is a PPO? A PPO is a "Preferred Provider Organization". In a PPO, doctors are contracted by the health insurance company to give its members discounted rates on their services. A PPO typically has a deductible and a co-pay, or a percentage you are required to pay for your medical bills. If you decided to see a doctor outside the provider network, you should expect to pay a higher percentage of your bills. |
What is an HMO? An HMO is a "Health Maintenance Organization". With an HMO you choose a Primary Care Physician (PCP) within the HMO's provider network. Your PCP will be your regular physician and will issue referrals for you to see a specialist. HMOs give you a very wide range of services to choose from with very low co-pays and sometimes no deductibles, but most times will not cover you if you do not have a referral from your PCP or if you choose an out-of-network doctor. |
What is a POS plan? A POS plan is a "Point of Service" plan. These plans require you to pick a PCP from the provider-network and offer the services from your PCP at little to no deductible. With a POS you are usually offered better coverage by your PCP or from services that your PCP gives you a referral for, but you may still get services from out-of-network providers for a deductible and lower level of coverage. In addition, services outside the network may have to be paid up-front and you may have to submit a claim to the insurance company. |
What is an HSA plan? An HSA plan is a "Health Savings Account" plan. This type of plan allows you to put pre-tax money into a savings account which can be used with a high deductible health insurance plan to pay for your medical bills. |
What is a co-pay? A co-pay is a charge that the health insurance plan requires you to pay when you get a medical service or a
medical supply. After the co-pay is paid, in most cases, the insurance company will pay the rest of the bill for that service or |
What is a deductible? A deductible is the yearly amount which your insurance company requires you to pay before it will start making payments for your insurance claims. |
What is coinsurance? Coninsurance is the amount you are required to pay for a claim that is other than your deductible or co-pay. |
What is a provider network? A provider network is the network of doctors and health care providers that are contracted by your insurance company to provide their services. Health care providers in the provider network offer their services for a negotiated rate. |