There are plenty of medical terms that govern health insurance that everyone has heard – yet they may not really know. Some terms are easy to understand, while others are downright odd. Before you start to read too much into your health insurance policy, there are some main medical and insurance terms that you need to be aware of. Here are 8 that you should know so you can properly understand your insurance:

Premium – for many people, this is what your employer, or sponsor, will pay each month for your health insurance. Sometimes, individuals pay this amount to their employer or directly to the health insurance company. This, in turn, covers you under their insurance.

Deductible: This is the amount that you have to pay from your own pocket before the insurance will take care of their part.

Copayment: This is the amount that you have to pay at the time of service (such as doctor visits, hospital stays, etc), that comes out of your pocket before your health insurance will pay the remainder. This is normally a small amount, usually under $50.

Coinsurance – many people have this, especially seniors that are on Medicare. This just means that you have one main health insurance plan and then another, smaller plan (coinsurance) that covers the remainder of the bill. Many people that are on fixed incomes have coinsurance so that they aren’t stuck with massive unexpected expenses.

Coverage Limits: There are some health insurance policies that will only pay for a specific set amount of different types of coverage. For example, they may only pay up to $1000 a year on basic physicals for your entire family. This is one area where you need to check your health insurance plan well so you aren’t caught with payments that you thought we covered.

In-Network – this is the term that is used to cover the doctors and other medical professionals that accept that specific health insurance. When you sign up for health insurance, you will normally get a book with a list of “in-network” providers that have already made an agreement with the health insurance company.

Prior Authorization – normally, health insurance companies will require that you have prior authorization either from them or from your primary care physician before you see a specialist. So, when you need to go to an OB/GYN or surgeon (or other specialized medical professional) you will need to check and see if you need to get a prior authorization to ensure that their services are covered.

Capitation: This is the overall amount that your health insurance company will pay to your medical professional (i. E. Doctor, surgeon, dentist) to ensure that they will see anyone covered under their health insurance plan.

While there are thousands of other health insurance terms that you should get to know, you should also take the time to read through your insurance plan so that you will be familiar with what is covered and what is not. There are so many different health insurance plans and different things that are covered and aren’t, so you need to be aware exactly what you have coverage for and what you might need in the future.

Dawn Enstruthe writes for website DS Health Insurance which info on topics like dental insurance for low income people and cheep dental insurance for seniors.

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Health insurance plans become increasingly necessary because of the increasing costs of medical care, hospitalization and medicine. The great majority of the affected by the lack of any form or medical care are the seniors, which is the population that is more vulnerable to health problems.

Nowadays, the role that health insurance plans play within the family economy is very important provided that they give reassurance when an unplanned event happens. In general, these plans are contracts by which the insured is reimbursed in case of illness or hospitalization.

There are some health insurance plans that could provide health coverage for people of old age in exchange for the payment of a fee every year. In order for seniors to be accepted as such by insurance companies, they need to be older 65 or whatever the national profile is. Some policies apply to people that are older than 70 or 75 years.

The criteria for a person to be approved by a health care provider should not be age but health condition. In this scenario, an insurance company will judge whether a person qualifies for a plan on the basis of their health not age. So for instance, if a person has heart condition and poor health, he or she would be likely to be rejected regardless of their age. Unfortunately, age determines how high or low the monthly payments for the health insurance plan will be.

Health insurance plans offer the insured the possibility of visiting highly qualified doctors that work in emergency rooms or clinics. Another benefit of these kinds of plans is that they compensate the insured with a fraction of the cost of the medical bill. Additionally, your health insurance plan could cover you whether you are in the country or not, when the time in the foreign country is not over the three months.

Among the other benefits that health insurance plans provide are: accidents, accidental death, organ loss, funerary costs, etc. When the reason of the death of the insured is due to covered illness or accident, the plan would also provide benefits to the dependents for a total of three years.

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With constant increases in the cost of visiting the dentist, many people debate the decision of whether to buy dental insurance. Whether you are considering buying dental insurance through your employer or independently, be sure to investigate several different plans and ask questions which are detailed below. This information will help you choose the proper dental insurance plan for you before signing the contract of insurance.

All dental insurance plans have an annual maximum which is the ceiling of coverage that your insurance provides. It renews itself after each year of your insurance. The benefits that you have enjoyed during this year will not be sent to the following year. In short, you can only use those benefits once a year. The maximum coverage that most dental insurance give is a $1000 year. Policies may vary depending on the provider of the service, but generally dental insurance policies will only cover services of practitioners that are part of their network. Before you visit a clinic, make sure you understand the terms of the plan and what dentists you can visit, whether there is a network or if you may go to any. For your greater convenience, check the list of dentist in your neighborhood.

If you have discovered that your dental practitioner is not a member of the network covered by your dental insurance, find out whether your plan allows you visit a doctor outside the network. Unfortunately, when this is the case the coverage is not as good. The so-called the Customary and Reasonable Guide to Usual Fees is what most dental insurance companies use to determine the price of visit to the doctor. This means that the company will only reimburse on the basis of the fee they deem reasonable to pay regardless of how much your dentist really charged.

If your dental insurance plan allow you to continue visiting your current practitioner, he or she should not pay the difference. The dentist will expect to be paid from you, the full amount. They have an agreement with the insurance company where they are committed to charge you the difference. To avoid this from happening, make sure you find out what prices your insurance covers on that particular dentist you want to visit before you decide to ask for an appointment. Otherwise, you will be overcharged.

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Being hospitalized without having disposable cash can be hard. Most of the time hospitals do not accept insurance identifications- they require patients to make payments upfront.

It is quite common for international students to face the above dilemma when their Health Insurance for Foreign Students plans don?t offer direct cashless settlement. It is prudent for International students to seek plans that support direct cashless settlement.

Cashless claims settlements refer to the insurance company directly paying the hospital or the medical service provider. In such situations students are not required to pay the hospital and then file a claim with the insurance company.

Through a simple phone call the emergency help at the insurance company can arrange an ambulance on a special request or instruct the hospital to ready your room and also coordinate with the surgeon. In addition, the great thing about this is that there are no additional charges when you avail of cash-less settlement of claims.

Most insurance providers work with a special network of hospitals and doctors. This network is typically referred to as the Preferred Provider Organization or PPO network. When hospitals and doctors within the PPO are used claims can settled directly with the insurance company.

Cashless settlement of claims also does not discriminate on the age of the student. The no age limit on the plans allow students and their dependents to avail of the service easily with no additional and hidden costs.

A tip for international students: make sure while choosing your Foreign Student Insurance, that it supports direct cash-less settlement. It is important for new students in the US to secure their health and finances while they pursue their academic goals.

Your International Student Advisor at the University or College can sometimes help you in selecting an appropriate plan. The University may require certain insurance waiver forms to be completed by the insurance company.

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I always like to ask my clients, “Will your financial planner be willing to pay your long term care bills, will they have access to good quality Home Health Care Providers?” Many lawyers and advisors are now reluctant to recommend against Long Term Care Insurance for fear of law suits later on, from children, when hundreds of thousands of dollars were required to pay for their parents long term care bills. Planners who fail to recommend coverage are more times than not, unaware of the real RISK of needing care one day.

The senior has now become the GREATEST financial risk that Americans face today. The majority of them are unaware of it because let’s face it: No One wants to think about needing Long Term Care. It is going to happen to someone else! Long term care bills are the biggest reason for financial failures among seniors today. Yet there are a lot of Financial Planners and Investment advisers who will say that you don’t need Long Term Care Insurance.

If you already have a lot of money, perhaps you don’t! The question is: Would it be a smart decision to have this coverage? What we are seeing today are many Financial Planners split on the subject of LTC Insurance. You will hear some say that if you have any resources you should not be without it, that it is an integral part of financial planning, while others think if you have enough money you should self-insure. Who is right?

Every financial adviser I talk with would recommend long term care coverage if he knew in advance that his client would need several years of long term care. Do the math. In a state where long term care bills are averaging $170 per day, and the average premium is $4000 a year for a couple, aged 60, and they live another 20 years, they have paid out $80,000 in premiums for the peace of mind that they will not go broke. Without the insurance, they could end up paying over $80,000 in less than two years for ONE OF THEM on the advice from a Financial Planner telling them that they DON’T NEED IT! It must be concluded that Financial advisers who recommend against LTC Insurance figure you are not going to need care since they would recommend you obtain coverage if they knew you were going to have to spend several hundred thousand dollars. You should find out from the adviser what is the BASIS for their prediction? Also, be aware that advisers are sales people. They are in the business of making you money.

If you purchase Long Term Care Insurance, you have less money for them to manage! The decision is yours. At this point in your life, are you more interested in making a few more thousand dollars a year or are you more interested in protecting what you have already earned from the most DEVASTATING financial risk that people face in America today? One of the biggest financial mistakes a person can make today is needing Long Term Care and having no coverage! Is this a mistake you want to take a chance on making? Seek out a LTC Insurance Specialist to help you make the best informed decision for you and your family. Remember, your Financial Planner or adviser is not going to pay your long term care bills. You will!

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