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Your
Quick and Easy Guide to Group &
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Point of
Service or Fee-for-Service Plan
This is old-fashioned medical insurance and typically the most expensive.
You pick your doctor or medical service, and your insurance pays
for the bill.
Health
Maintenance Organization (or HMO)
Your insurance will allow you to use only those doctors and hospitals
in the HMO. You have to get permission from your "primary care
physician" to go to a specialist or to use any HMO services.
Preferred
Provider Organization (PPO)
This is a combination of HMO and POS. You choose your doctor, but
your insurance may pay more if you choose a doctor it "prefers."
A PPO may be a viable option if you're looking for a
cheap health insurance without compromising on the quality of
coverage.
Medical
Savings Account (MSA's)
This is a new idea in insurance. The money you put into this account
pays for deductibles and co-payments. Words like 'cheap' and 'affordable'
are seldom used to describe health plans, however, MSA's can often
reduce premiums substantially.
Important Terms in Health Insurance
Primary
Care Physician
Another term for the family doctor.
Provider
Anyone who gives medical services is a "provider," like
doctors, nurses, and x-ray technicians.
Premium
If your "monthly premium" is $20, it means your insurance
costs $20 a month.
Deductible
If you get sick or need medicine, your insurance may not pay the
whole bill. For example, your medicine costs $100, but your insurance
pays $80. That $20 you pay is your "deductible."
Co-payment
This is the amount you pay each time you visit your doctor or get
a prescription.
Major Medical
Policy
This policy does not pay unless you have a big medical bill. For
example, you can buy insurance that does not pay until you have
over $5000 in medical expenses.
Covered
Expenses
Your insurance will only cover the items listed in your policy.
Most policies will not cover mental health, drugs, dentists and
so forth.
Exclusions
This term is the opposite of covered expenses. Exclusions are what
the policy does not pay for.
Guaranteed
Renewable Policy
If your policy is “guaranteed renewable,” it means that
even if you get a really serious disease like cancer, the company
cannot cancel your insurance. However an insurer may change premium
rates or benefits at a certain age by class.
Limit of
the Policy
The maximum amount of money paid for all covered expenses during
your lifetime.
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