So much information is out about health insurance companies and their coverage; it is difficult to wade through it all. We have gathered together here a simple guide for you to understand some of the basics of health insurance companies, coverage, their practices and jargon so you can find the company that meets your needs.
Q: What is a premium? How much do I need?
A: A premium is the amount you pay to the health insurance companies for their coverage. It can vary depending on the company and how many people you cover, from hundreds to thousands each year. Two tips for saving money on premiums: raise your deductible. This will lower your premium. Also, if you pay your premium annually, you will save on service fees and possibly be eligible for an early payment discount.
Q: What is a Deductible? How much should I pay?
A: A deductible is the amount you pay on your own to cover major medical costs (depends on the various health insurance companies which types of medical procedures you pay for) before they begin coverage. Again, if you and your family are generally healthy, you can raise your deductible and lower your premium.
Q: Do they work on a co pay or percentage pay system? What prescription coverage will I receive?
A: Different health insurance companies can go different ways. With health insurance companies with co pay system, you pay a set amount each time you go into the office or get a prescription. These health insurance companies will save you money, but they may eventually take it out of your plan or raise your premiums. Health insurance companies that participate in a percentage system have you pay a percentage of the bill. This can be expensive if you get sick, but health insurance companies may prefer this option.
Q: I’m confused about health insurance companies with all these letters. What is the difference between a PPO and an HMO?
A: A PPO is a Preferred Provider Organization. These health insurance companies allow you to see any of the doctors in a network of approved doctors or a licensed provider outside the network, but you will probably pay more for out-of-network services. These health insurance companies are usually low-cost. HMO’s are health insurance companies which are highly organized and only allow you to see pre-approved doctors except in emergencies. You have one doctor as your point of access for most of your needs, but these health insurance plans are generally low cost. Other health insurance companies offer indemnity plans, or the traditional options in which you choose the doctors and you have more control. These are usually more expensive.
Q: What is a claim? How do I make one?
A: A claim is basically the “bill” for the health insurance companies. Most healthcare providers will file claims electronically with health insurance companies, but sometimes they send the bill to you directly. In this instance you will have to file with they company yourself. Other times, healthcare providers send bills to you for review after filing with health insurance companies. Call your company for their steps for filing and for your questions about filing.
Before you make any decisions, be sure you shop around for the best deal and the best coverage that fits your needs. Good luck and happy hunting!
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