Insurance Fundamentals

Insurance is used to diversify everyone’s financial risk.
Individuals and families pay the insurance company a monthly (premium) fee and the insurance company guarantees that they will pay for eligible medical claims.

Some Terms to know include:
DEDUCTIBLE
A deductible is how much you have to spend for covered health services before your insurance company pays anything.

COINSURANCE
Coinsurance is your share of the costs of a covered health care service. The coinsurance is calculated as a percentage (for example, 20%) of the allowed amount for the service.

COPAY
A copy is the Amount you pay per dedicated services as outlined on your plan typically after you have satisfied your deductible.

OUT-OF-POCKET MAXIMUM
The out of pocket maximum is the most you have to spend for covered services in a calendar or policy year. After you reach this amount, the insurance company pays 100% for covered services.

NETWORKS
A group of doctors and medical care providers across multiple specialties that have a contract to provide health care services to members of a health insurance plan.