Health Insurance

Having the proper health insurance coverage can literally be a matter of life or death. We'll make sure you're family is properly covered with health insurance premiums you can afford.

What is Health Insurance?

Health insurance is coverage that provides for the payments of benefits as a result of sickness or injury. Includes insurance for losses from accident, medical expense, disability, or accidental death and dismemberment.

Health Insurance Types

Health Maintenance Organizations (HMOs) and Exclusive Provider Organizations (EPOs)
  • HMOs and EPOs may limit coverage to providers inside their networks. A network is a list of doctors, hospitals, and other health care providers that provide medical care to members of a specific health plan. If you use a doctor or facility that isn't in the HMO’s network, you may have to pay the full cost of the services provided.
  • HMO members usually have a primary care doctor and must get referrals to see specialists. This is generally not true for EPOs.
Preferred Provider Organizations (PPOs) and Point-of-Service plans (POS)
  • These insurance plans give you a choice of getting care within or outside of a provider network. With PPO or POS plans, you may use out-of-network providers and facilities, but you’ll have to pay more than if you use in-network ones. If you have a PPO plan, you can visit any doctor without a referral.
  • If you have a POS plan, you can visit any in-network provider without a referral, but you’ll need one to visit a provider out-of-network.
High Deductible Health Plan (HDHP)
  • High Deductible Health Plans typically feature lower premiums and higher deductibles than traditional insurance plans. 
  • If you have an HDHP, you can use a health savings account or a health reimbursement arrangement to pay for qualified out-of-pocket medical costs. This can lower the amount of federal tax you owe.
Catastrophic Health Insurance Plan
  • A catastrophic health insurance plan covers essential health benefits but has a very high deductible. This means it provides a kind of "safety net" coverage in case you have an accident or serious illness. 
  • Catastrophic plans usually do not provide coverage for services like prescription drugs or shots. 
  • Premiums for catastrophic plans may be lower than traditional health insurance plans, but deductibles are usually much higher.


Basic Health Insurance Terms to Know
Health insurance seems to have a language all its own. Learning the common terms and how they're applied – especially to your own policy or to a new policy that you're interested in – can help you make more informed choices about your health coverage.

ACA Minimum Essential Coverage
Affordable Care Act (ACA) Minimum Essential Coverage is the type of insurance you need to have to avoid a tax penalty under the Affordable Care Act (ACA). All health plans must cover what are known as “essential health benefits,” including:
  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Laboratory services
  • Maternity and newborn care
  • Mental health and substance use disorder services including behavioral health treatment
  • Pediatric services, including oral and vision care
  • Prescription drugs
  • Preventive and wellness services and chronic disease management
  • Rehabilitative and habilitative services and devices

Benefit
A benefit is a service or supply that is covered under a health insurance plan. This might include office visits, lab tests, and procedures during the course of treatment.

Coinsurance
Coinsurance is the percentage of covered medical expenses that you are required to pay after the deductible. Let’s say your health insurance plan has a 20% coinsurance requirement (excluding additional copays). Once you have met your deductible for a $100 medical bill, you would pay $20 and the insurance company would pay $80. You might see this referred to as 80/20 coinsurance. Some plans offer 0% coinsurance, meaning you’d have no coinsurance to pay.

Copayment (copay)
Often shortened to copay – it’s a set amount that you’ll pay for certain medical services or supplies at the time of service. Doctor visit copays commonly run from $35 to $50. Prescription copays often are $15 to $60 depending on the type of drug purchased.

Deductible
A deductible is an amount your insurance plan will require you to pay out-of-pocket for covered expenses before the plan pays benefits. With ACA plans, a deductible will usually cover one calendar year. Short term plans have a per-term (number of coverage months you select) or per-cause (separate for each illness or injury) deductible. A higher deductible usually results in lower premiums.

Indemnity Plan
An indemnity plan is a health insurance plan that reimburses the covered person for incurred medical expenses. Indemnity plans often include a deductible that must be satisfied before claims can be paid. Covered persons can usually see any qualified provider without a change in benefits. Indemnity plans are sometimes called fee-for-service plans.

Marketplaces
Health insurance marketplaces, or "exchanges," are a way for people to shop for and buy health insurance, which may be referred to as a health plan. Each marketplace is divided between individual (for families and individuals) and SHOP (health plans for small employers) marketplaces.

Network
A network is a group of physicians, hospitals, and other health care providers that have agreed to provide medical services at pre-negotiated rates.

Open Enrollment Period
The open enrollment period refers to the period of time (usually once per calendar year) when people can freely apply for a health care plan or change their benefit selections.

Premium
Premium is the amount paid for health insurance coverage for a specific period of time.

Special Enrollment Period
A special enrollment period refers to the period of time (usually 60 days) when people become eligible to apply for a health care plan or change their benefit selections due to experiencing a qualifying event, such as job loss, having a baby, or being disqualified from Medicaid.

Underwriting
Underwriting is the process the health insurance company uses to review an application to determine the insurability of the applicant(s). ACA plans are guarantee issue and do not require underwriting. 

Waiting Period
Waiting period is a time period after you start a health insurance plan when coverage may not be available for some medical conditions.

  • Contact us to learn more about the right health insurance for you.
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