Understanding California Health Insurance terminology
August 31st, 2011If you are looking into California health insurance, you may find yourself a little puzzled by all the terminology out there. This is a brief overview of some of the more common terms:
Managed care refers to a health coverage system that is managed within a network of practitioners. This includes:
- Health Maintenance Organizations (HMO), with which you get all of your medical treatment from health providers within the network.
- Preferred Provider Organizations (PPO). This coverage generally costs less than HMO, and involves paying a discounted set fee for services sought within the network of practitioners.
- Point-of-Service or POS. With this option you may still be covered if your doctor refers you to health practitioners outside the network.
Indemnity Plans are more flexible, allowing you to choose your own hospitals and doctors. Within these are:
- Employer-sponsored coverage which is health coverage available through your work.
- Health savings accounts, a tax-deductible option, which allows you to save specifically for health expenses.
- High-deductible plan, which usually involves paying a $1,000 deductible when making claims.
Other terms:
- Co-payment: a set fee you need to pay for services.
- Co-insurance – a percentage of costs you pay after deductibles.
- Deductible – the amount you must pay when making a claim before other costs are covered by your insurance provider.
- Fee-for-service – the ability to choose your own providers.
- Exclusions – items not included in coverage.
- Formulary – a list of medications that are covered.
- Out of pocket – the deductibles, co-payments and co-insurance you need to pay.
- Annual limit – the predetermined amount of medical costs that an insurance provider will cover each year.
It’s really no surprise that choosing the right California health insurance can be frustrating, but it pays to get it right. ...
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