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Don't be afraid to ask questions. Understanding is crucial to making
the right choice regarding your health coverage.
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Remember, if you visit the related links page you may possibly find
what you need.
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Deductible
The deductible is the amount of money that the insured would need to pay before any
benefits from the health insurance policy can be used. This is usually a yearly
amount so when the policy starts again, usually after a year, the deductible
would be in effect again. Some services, like doctor visits, may be available
without meeting the deductible first. Usually there are separate individual
deductible amounts and total family deductible amounts.
Co-insurance
This is the amount that would need to be paid by the insured before the
insurance pays and in addition to the deductible. Some health insurance plans
will let the insured use some services with just the coinsurance payment, like
visiting the doctor, even before the deductible is met.
Co-payments
This is another term used for, or in place of, coinsurance.
Out-of-Pocket
This is the cost one would pay out of their own pocket. An out of pocket expense
can refer to how much the co-payment, coinsurance, or deductible is. Also, when
the term annual out-of-pocket maximum is used, that is referring to how much the
insured would have to pay for the whole year out of their pocket, excluding
premiums.
Lifetime Maximum
This is the most amount of money the health insurance policy will pay for the
entire life. Pay attention to individual lifetime maximums and family lifetime
maximums as they can be different.
Exclusions
The exclusions are the things that the insurance policy will not cover.
Pre-existing Conditions
This is something someone had before obtaining the insurance policy. Some plans
will cover pre-existing conditions while others may completely exclude them and,
in addition, some health insurance plans will cover pre-existing conditions
after a certain time period.
Waiting Period
This is the time one would have to wait until certain health insurance
coverages are available.
Coordination of Benefits
If the insured has available two or more sources that would cover payment for
certain conditions, such being under a spouse's insurance plan along with their
own, the insurance company would not pay double benefits. In this case the
health insurance company would coordinate benefits to make sure each plan pays a
portion of the service.
Grace Period
This is the amount of time one has to pay their health insurance premium after
the original due date and before insurance coverage would be canceled.
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