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

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.

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

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.

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.

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