Insurance Speak [Show Notes]

Insurance Speak – Episode 47

– Premium – it is like paying dues to be in the club, and being in the club means that the insurance company will have to pay for your care if you get sick or hurt.
– Deductible – a portion of costs that you are 100% responsible for before the insurance company chips in.  Low premium = high deductible.
– Copay – Co = together, pay = payments; you and your insurance are paying the total bill together.  Copays are usually standardized, and are a price predetermined by the insurance.  Medication copays are broken down into Tiers.
– Coinsurance – rather than a set price, it’s a set percentage.  Based on the total cost of the service, the price you pay may change.
– Out Of Pocket – OOP; some insurances keep track of all the money you pay and they have a limit (called Lifetime Maximum or Lifetime Limit).  If your costs reach that limit, the insurance will take care of everything after that.
– Formulary – a list of medications that insurance decides they will pay for.  Insurance can change this whenever they feel like it.
– Prior Authorization – insurance requires the payment of a particular medication or service to be authorized prior to them paying for it and/or you receiving it.  Usually require documentation and justification from your doctor.
– Networks – Providers in the Network usually have a negotiated discount or other beneficial contract with the insurance, which will translate to lower costs for you.
– HSA – Health Savings Account; YOUR money that you put back to use to pay for healthcare costs in the future.  Does roll over.
– HRA – Health Reimbursement Account; an incentive from your employer or insurance for you do things to prevent illness, and then THEY will give you money to pay for your healthcare costs.  Does roll over.
– FSA – Flex Spending Account; YOUR money that you put into an account to pay for healthcare costs or health related items (some OTC things are approved).  They usually require receipt submission to prove you purchased approved items.  But if that money is not used by the deadline, it does NOT roll over, you do not get it back.

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“Radio Martini” Kevin MacLeod (  Licensed under Creative Commons: By Attribution 3.0

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