Insurance Terminology

We know that sometimes the insurance industry uses words that can get confusing; we wanted to give you a brief explanation of common used insurance terms

Open Enrollment
Open Enrollment is the time of year you can obtain OR change health insurance coverage; there are four types of open enrollment opportunities:

1) Annual Open Enrollment Under 65 Policies – October 15th through February 15th
2) Special enrollment periods qualifies you to obtain coverage if you have a life changing event as; loss of current group coverage, birth, adoption, marriage, divorce, moving out of state, etc. Please call us to see if you qualify under one of the eligible provisions.
3) Annual Open Enrollment For Over 65 Medicare Policies – October 15th through December 7th
4) Special Enrollments For Medicare Policies – you qualify to enroll into Medicare policies when you turn 65 OR when you come off a group health plan.

Premium Subsidy
The amount paid by the Federal government to lower your health insurance premiums

Deductible
The amount you pay up front before your insurance policy begins to pay

Coinsurance
After you meet your deductible, the insurance carrier pays part of the bill and you pay the remaining portion (as an example the insurance carrier pays 80% / you pay 20%)

Copay
The amount you pay at time of service, an example is a $10 copay for a prescription; you pay the $10 and the plan pays the balance

Maximum out of Pocket
This is the total amount you will pay annually out of your pocket for “in-network” claims. This total includes your in-network deductible, coinsurance, and copays