Congratulations! You now are the proud owner of a health insurance policy through your work place
But if you are like most of us, you have no clue what anything in it means. You start reviewing the policy and it gets more confusing as each word is read.
The first thing to understand is that you are not alone. This happens to a lot of people.
Insurance policies for the most part are simple to understand, if you know the language they speak. But if you don't, then that's another story.
So let's get started and see if we can help you make sense of your new health insurance policy.
The first things you want to understand are the many terms that are in your policy.
- Deductible. A deductible is what you would have to pay before any benefits in your health insurance
policy would be accessible. Usually this is an annual amount and will vary greatly by the underwriters of
the policy. Most of the time there are separate deductibles for an individual account and a family account.
Some policies will let you use some of their services without meeting the deductible. Once you meet your deductible then you're done paying for that calendar year. The following year, however, you will have to start all over again.
- Co-payment. This is an amount that is paid by the insured before the insurance will pay for something. This payment is in addition to the deductibles. For example, a $20 co-payment for doctor visits means that when you go to the doctor's office for whatever reason, it costs $20. Some policies let you pay a co-payment for certain services without meeting the deductible.
- Out of pocket. This is the maximum amount you will have to pay out of your own pocket (duh). This could include your deductibles and your co-payments. If you hear the term "annual out of pocket expense" this is the maximum amount out of your own pocket you would have to pay for the services less the premiums, which are due no matter what.
- Lifetime maximum term. What this means is that your policy basically has a cap on it. During the policy's lifetime you can't go over a predetermined amount, or else the health insurance won't pay after that set amount. It's usually a very high amount, but with today's rapid escalating health care costs you could reach it fairly quickly.
- Exclusions. The exclusions section will be one section that you must read very carefully and fully understand in your health insurance policy. Exclusions are the things the policy will not cover and this can be a very gray area. For example, the policy could cover operations but not after-care, or it could cover the after-care and not the operation. This is one of the most important sections of your policy, so read and reread it over a lot to make sure you grasp all of the contents of what it covers and doesn't cover.
- Pre-existing conditions. A pre-existing condition basically means some health problem you already have and been treated for, which the policy will not cover. The policy will not pay for any future work done for it. Some health insurance policies will cover pre-existing conditions while others won't, which is why knowing what is in your policy is very important.
- Waiting period. This is usually the time you will have to wait for your health insurance policy to become effective. Most policies do have a waiting period and the benefits aren't available until you have met the waiting period requirements.
- Grace period. This is the amount of time that is given for one to pay their health insurance premium after the original due date has passed. So a grace period of 30 days means you have up to 30 days after your due date to pay your premium, before the policy is cancelled.
There are many things that you should always remember as you look over your health insurance policy. Read each and every paragraph and make sure you understand how the whole policy works so you will never be in the dark or have any questions about what is covered and what isn't. Remember that it is always okay to ask questions!