March 12, 2020

Health Insurance Dictionary

Cedric Kovacs-Johnson

The most important health insurance terms, explained in language anyone can understand.

Healthcare is full of jargon. Here are some of the words you need to know (in plain English):

 

Deductible: The amount you personally have to pay before your health insurance starts sharing costs. 
(So: if your deductible is $1,000, you have to buy $1,000 worth of covered care before the plan helps pay for anything).

 

Copay: How much you pay at the front desk. Could be $0 , could be $50 depending on what type of plan you have and what type of doctor it is.

 

Coinsurance: For some services or prescriptions, you're required to pay a percentage of the total charges.
So if the charge is $100 and your coinsurance is 50%, you pay $50.

 

Premium: The amount taken out of your paycheck each month.

 

Covered: Yes your health plan will pay for this. (common examples: doctor's office, pediatrician, mammogram).

 

Not Covered: No your health plan will not pay for this. You'll have to pay for these on your own, and they won't count toward your deductible or out-of-pocket max (common examples: lasik eye surgery, nose job, accupuncture...).

 

Facility: Hospital

 

Provider: Doctor

 

Family deductible: the collective amount spent on covered services for all family members before the plan starts paying - it's not per person.

 

Plan Document: The thick stack of papers you'll get when you sign on for a new plan that includes every little detail about your plan. It will tell you exactly what your deductible, copay, coinsurance, etc. are.

 

Out-of-Pocket Maximum: The most you'll have to pay for healthcare in a given year. It includes things like your deductible, copays, and coinsurance payments. This number is explicitly stated in your Plan Document, so consult that before going on. It does not include your premium.

 

Covered-in-full: When a service is paid for entirely by your plan. In other words, FREE!

 

Prior Authorization: Your insurance company has to give their permission for you to have this procedure. If you don't receive prior authorization, the service might not be covered.

 

Referral: When your doctor recommends you go see a specialist. These services are usually covered, but sometimes they require pre-authorization.

 

Explanation of Benefits (EOB): The piece of paper you receive in the mail 25 days after every appointment. It describes your visit, and tells you how much money (if any) you owe to the provider. An EOB is not a bill - it's just for your information. If you receive a bill that is different than what it says on your EOB, call the Flume Concierge right away 1-866-754-1660.

 

If you have ANY questions about your health plan or what something means, just call us! 844-MyFlume (844-693-5863)

 

Is there another term you'd like to see added to this list? Let us know!

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