Simply having the basic understanding of insurance definitions can make the difference between having a plan that will cover you for the majority of your medical expenses and one that leaves you paying thousands of dollars.
Co Health Brokers has selected the top 10 terms you should know for self-funded healthcare plans. #1 Affordable Care Act Also known as the Patient Protection and Affordable Care Act, or "Obamacare," this is the healthcare reform legislation signed into law by President Obama in 2010. Some provisions of the law, such as universal coverage for preventive services, are already in place. #2 Cancellations In the past, some insurance companies would cancel health coverage because you made a mistake on your application. Under the ACA, companies are no longer allowed to do that, although they can cancel your coverage if you knowingly falsified or omitted information on your application or if you don't pay your premium on time. #3 Pre-existing Conditions Pre-existing conditions include any injury or illness that you may have prior to getting the insurance plan. The definition can vary by plan so it’s important to check with your plan to see the exact definition. #4 Premium This is the actual cost of your insurance plan. The higher the premium, the higher your coverage and thus, the less you will have to pay in medical bills throughout the year. #5 Co-Pay Like a deductible, this is the amount of money you must pay out of pocket before the insurance company begins to pay for your eligible expenses. Typically this is required instead of a deductible or coinsurance and requires you to pay a set fee for a specific visit. #6 Self-insured Employers choose this model of funding to pay for health claims from company assets and employee premiums. Self-insurance allows employers to pay only for actual claims, instead of the fixed premiums of fully-insured plans. A 2013 study by the Health insurance brokers Denver noted three of five covered employees are in self-insured health plans. #7 SPD Summary Plan Description that lists health plan terms and conditions, written for a particular employer or organization. The SPD defines the benefit coverage and exclusions. Colorado health insurance ensures that coverage and exclusions mirror the stop loss contract. #8 Fixed Cost Predetermined fees that are paid as part of a health plan, regardless of actual expenses. Fully-insured plans are 100% fixed cost, paid out in setting premium rates to the carrier. Self-insured fixed costs range from 18%—21% of total plan costs for administrative fees and stop-loss insurance. #9 Benefits Administrator Also called a third party administrator (TPA) or administrative services organization (ASO). Employers typically contract with an administrator to handle benefits plan documents, claims payments and provide other services. Experienced administrative companies like Colorado health insurance can preserve significant savings for employers through careful management of resources, with customized benefits and targeted products to meet employer needs. #10 Coinsurance Coinsurance is a percentage of what the insurance will pay to cover your health care cost after any deductibles or copays have been met. Finding an affordable health insurance plan can be difficult; especially if there are insurance terms you actually don't understand. Been aware of all the above terms will not only help you to choose the best plan for you but will also save your time. Also Read: 10 EHBs That You Should Know in Health Insurance Plan
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The Affordable Care Act ensures Americans have access to quality, affordable health insurance. To achieve this goal, health insurance Denver ensures that health plans offered in the individual and small group markets, both inside and outside of Health Insurance Plans, offer a core package of items and services, known as “Essential Health Benefits.”
Co Health Brokers team will let you know about the 10 EHBs that you should know in health insurance plan in detail. These essential health benefits include at least the following items and services:
Specific health care benefits can vary state by state. Health insurance Denver will explain to you how and where, even within the same state, there can be small differences between health insurance plans. Under Colorado health insurance agency, when you fill out your application and compare plans, they will make you see the specific health care benefits each plan offers. Also Read: What Is Obamacare And How It Changes The Health Insurance Industry? |
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