Knowing the ins-and-outs of an insurance plan will go a long way in helping to make the most of out of one's health coverage. From meeting the deductible to knowing what services fall under preventive care, understanding what a plan covers - and what it doesn't - will make sure there are no curve balls when medical bills arrive by mail.
For details on what a specific insurance plan covers, refer to the plan's Summary of Benefits and Coverage.
The effective date for insurance coverage is the date that the coverage is officially active. As of the effective date of coverage, the enrollee can receive services and the ins... Learn more
A deductible is the amount of money someone has to pay out of pocket for medical expenses before health insurance kicks in and begins covering the expenses. For example, an... Learn more
Insurance carriers will designate a provider as either in-network or out-of-network: An in-network provider is a doctor, specialist, etc. that has contracted with the insuranc... Learn more
Coinsurance is a percentage of the total cost of a medical service that is paid out-of-pocket, but the percentage may vary depending on whether the service received is inside or... Learn more
Under the Affordable Care Act, health insurance plans must offer Prescription Drug coverage as an Essential Health Benefit. Prescription Drug Tiers Prescription Drugs... Learn more
Under the Affordable Care Act, health insurance plans must offer emergency coverage, including Emergency Room visits and emergency transportation (ambulances, etc.). ER vis... Learn more
Pharmacy Benefit Managers (or PBMs) such as Express Scripts are mail order services for prescription drugs. PBMs are usually third-party administrators, but can also be par... Learn more
This page contains a glossary of key terms related to health insurance. Health Insurance Terminology Cafeteria Plan: A plan that is maintained by an employer for em... Learn more
Insurance carriers offer plan riders which companies may choose to add to their basic insurance plans. Plan riders augment basic plans by providing additional coverage ... Learn more
Copays for High Deductible Health Plans (HDHPs) work a little different from other types of plans. Typically with HDHPs, employees must meet their deductible before the carr... Learn more
A copay, or copayment, is the amount paid out of pocket after a doctor's visit or when paying for prescription medicine. Copays may vary from one plan to another, and emerge... Learn more
There may be different deductibles for seeing in-network or out-of-network providers. Out-of-network deductibles are higher than in-network deductibles in order to incent... Learn more