8 Health Insurance Terms You Need To Know

Tuesday, September 1st, 2009

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.