Six basics you must know about health benefits
Six basics you must know about health benefits
Understanding these 6 basic ideas can help you save money and get the most out of your plan.
- Premium: This is what you pay for health insurance. Sometimes you don’t pay the entire monthly premium yourself. This is common when you get your health insurance through your job.
- Provider network: Health care providers in the network have agreed to offer care and services at discounted rates. This means you pay less when you see an in-network provider. The network includes doctors and many other health care providers.
- Prior authorization: Is a requirement to obtain advanced approval to provide specific services or procedures. Prior authorization is required for many health services. To learn more about prior authorization, see this month’s IMP article Get the care you need — and avoid a surprise bill!
- Claim: This is simply a request to pay for a health service covered by your plan. Usually, an in-network provider sends us all the information. However, if you use an out-of-network provider, you may have to send the claim form.
- Cost sharing: Your health plan only pays part of your covered health care expenses. You’re responsible for paying some of your health care even when you have health coverage. This is known as “cost sharing” because you share the cost of your health care with your health insurer. The three most common types of cost sharing are Deductibles, Copays and Coinsurance. Not sure what some of these terms mean?
- Out-of-pocket maximum: Once you meet your health plan’s annual out-of-pocket maximum, your health benefits will pay 100% of your covered health care expenses for the rest of the year.