We all know how confusing insurance terminology can be. Here is a short list of the most commonly used terms to help you better understand the fine print on your policy:
HMO: refers to Health Maintenance Organization. HMO’s provides comprehensive health care by network physicians to those in a particular geographic area. With an HMO, you need to access care through a designated Primary Care Physician.
PPO: Preferred Provider Organization. PPO plan members receive full coverage by using doctors and hospitals within the PPO network, or they can pay more to go outside of the network for care.
Deductible: The initial amount you pay in a calendar year before particular covered services are covered by your coinsurance.
Coinsurance: The percentage of the allowable amount or billed charges that you pay for covered services after meeting any applicable plan deductible.
Copayment: The fixed amount and/or percentage amount you pay for covered services.
Copayment/coinsurance maximum: The limit on the amount you pay for certain covered services during a calendar year. Once the maximum is reached, your insurance carrier will pay 100% of the allowable amount for all applicable covered services (up to specified maximums) for the rest of the calendar year. Certain PPO plan covered services, such as office visits, generally do not count towards these maximums, and continue to be your responsibility.
If you have any questions on plans, rates, or terminology, please give us a call or send an email and we will be happy to help you!
