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TURNED DOWN FOR HEALTH INSURANCE BECAUSE OF YOUR PRE EXISTING CONDITION?
7 RELATED HEALTH INSURANCE DEFINITIONS
I’ve found that when a person is interested in purchasing an individual/family health insurance plan, he/she doesn’t fully understand the details of exactly what’s being purchased. Some of that is due in part to not having all the relevant terminology explained clearly enough which can cause misunderstandings and perhaps cost you later. Listed below are specific key terms that would behoove you to have a full understanding of when considering the purchase of health insurance coverage. Once you are familiar with these definitions, it will make you confident that you know exactly what you’re getting and what to expect when it’s time to exercise your health plan.
Deductible: The first dollars that you, as the insured, are responsible for before your insurer pays the claim. In other words, this is the part that you’ve gotta initially pay out of your pocket.
Coinsurance: In addition to your deductible, it’s a percentage of the covered portion of healthcare expenses that you as the insured are responsible to pay. For instance, on a standard 80/20 insurance plan, the insurance company pays 80% of the covered expenses and you pay the 20%.
Important point: The more involved or the higher the percentage an insurance company covers for you, the higher your monthly premium. They gamble that you will not need to exercise your annual out of pocket. And each month in the meantime, they make more money from your premiums. So the next logical question is: Why give your money to the insurance company before you absolutely have to? Well, you shouldn’t. Just get a plan with a higher coinsurance percentage because that makes your monthly premiums lower or more affordable. Many people aren’t aware about this.
Maximum Out of Pocket: It’s the maximum you will be required to pay when making a claim on an annual basis. Once you’ve paid your deductible and coinsurance, your insurer covers 100% of your remaining annual medical expenses no matter how many claims you have (up to the dollar amount of your lifetime maximum benefit).
Here’s a related sobering question: Have you ever wondered what the most common reason is for filing bankruptcy in the United States? You guessed it - medical expenses! That’s because people either don’t have any medical insurance at all which is most likely due to losing their job, or they can’t meet their out of pocket for the health insurance they’ve already bought. Even if you’ve gotta borrow money from your family or friends, or use your credit cards, your out of pocket must be met. So if you get into an accident or if you get diagnosed with a chronic illness (ie. diabetes, HIV, high blood pressure, etc. - something that you’ll have for the rest of your life) before you know it, you’ve been welcomed to medical expense hell.
HIPAA stands for Health Insurance Portability and Accountability Act of 1996.
Elimination Period aka Waiting Period: A specific amount of days that must pass by before a specific health benefit can be exercised.
Guaranteed Renewable: As long as you pay your premium, your insurance policy can not be canceled if you are diagnosed with an illness or condition that insurers would normally deny you coverage for. However, your premium can be increased; but it must be for everybody covered by that insurer; not singled out for only those with expensive health conditions.
Pre Existing Condition: A condition for which diagnosis, medical advice, care, or treatment was received or recommended during the six-month period prior to an individual’s enrollment date in the health insurance plan. This is usually recorded in your medical records. Interestingly, pregnancy is considered a pre existing condition; although it’s temporary because you are only pregnant for so long.
Uninsurable: Someone who can not medically qualify for health (or life) insurance because of having a pre existing condition.
There are more definitions; but the ones I’ve listed are the most important ones when considering individual/family health insurance coverage.
I’ve found that when a person is interested in purchasing an individual/family health insurance plan, he/she doesn’t fully understand the details of exactly what’s being purchased. Some of that is due in part to not having all the relevant terminology explained clearly enough which can cause misunderstandings and perhaps cost you later. Listed below are specific key terms that would behoove you to have a full understanding of when considering the purchase of health insurance coverage. Once you are familiar with these definitions, it will make you confident that you know exactly what you’re getting and what to expect when it’s time to exercise your health plan.
Deductible: The first dollars that you, as the insured, are responsible for before your insurer pays the claim. In other words, this is the part that you’ve gotta initially pay out of your pocket.
Coinsurance: In addition to your deductible, it’s a percentage of the covered portion of healthcare expenses that you as the insured are responsible to pay. For instance, on a standard 80/20 insurance plan, the insurance company pays 80% of the covered expenses and you pay the 20%.
Important point: The more involved or the higher the percentage an insurance company covers for you, the higher your monthly premium. They gamble that you will not need to exercise your annual out of pocket. And each month in the meantime, they make more money from your premiums. So the next logical question is: Why give your money to the insurance company before you absolutely have to? Well, you shouldn’t. Just get a plan with a higher coinsurance percentage because that makes your monthly premiums lower or more affordable. Many people aren’t aware about this.
Maximum Out of Pocket: It’s the maximum you will be required to pay when making a claim on an annual basis. Once you’ve paid your deductible and coinsurance, your insurer covers 100% of your remaining annual medical expenses no matter how many claims you have (up to the dollar amount of your lifetime maximum benefit).
Here’s a related sobering question: Have you ever wondered what the most common reason is for filing bankruptcy in the United States? You guessed it - medical expenses! That’s because people either don’t have any medical insurance at all which is most likely due to losing their job, or they can’t meet their out of pocket for the health insurance they’ve already bought. Even if you’ve gotta borrow money from your family or friends, or use your credit cards, your out of pocket must be met. So if you get into an accident or if you get diagnosed with a chronic illness (ie. diabetes, HIV, high blood pressure, etc. - something that you’ll have for the rest of your life) before you know it, you’ve been welcomed to medical expense hell.
HIPAA stands for Health Insurance Portability and Accountability Act of 1996.
Elimination Period aka Waiting Period: A specific amount of days that must pass by before a specific health benefit can be exercised.
Guaranteed Renewable: As long as you pay your premium, your insurance policy can not be canceled if you are diagnosed with an illness or condition that insurers would normally deny you coverage for. However, your premium can be increased; but it must be for everybody covered by that insurer; not singled out for only those with expensive health conditions.
Pre Existing Condition: A condition for which diagnosis, medical advice, care, or treatment was received or recommended during the six-month period prior to an individual’s enrollment date in the health insurance plan. This is usually recorded in your medical records. Interestingly, pregnancy is considered a pre existing condition; although it’s temporary because you are only pregnant for so long.
Uninsurable: Someone who can not medically qualify for health (or life) insurance because of having a pre existing condition.
There are more definitions; but the ones I’ve listed are the most important ones when considering individual/family health insurance coverage.