Health Insurance Terminology for the 99%

I’ve had some interesting conversations this past week and wanted to take a step back to discuss health insurance in general. I’m slowly learning that the vocabulary regarding health insurance is very foreign to some folks and they are having difficulty understanding the terms that are used. I want to take this opportunity to educate … Continue reading “Health Insurance Terminology for the 99%”

I’ve had some interesting conversations this past week and wanted to take a step back to discuss health insurance in general. I’m slowly learning that the vocabulary regarding health insurance is very foreign to some folks and they are having difficulty understanding the terms that are used. I want to take this opportunity to educate folks on some of the basics and how it pertains to you, the consumer.

So lets start off with the basics of insurance terminology in its most simple form- in regards to how it plays out in the medical world.

Premium- this is the amount of money you pay to have health insurance (your safety net), can be paid monthly, quarterly, or all at once.

Deductible- this is the amount of money that you must pay before your insurance even begins to cover costs. There are fine details associated with this but in my mind, this is how I think about it. These can vary from a few hundred dollars to $10,000, depending on what kind of insurance that you have.

Co-insurance- after you have paid the entire amount toward your deductible (the amount of money you pay prior to your insurance actually kicking money in), your co- insurance represents the amount of dollars you are still responsible for. Let’s use an example to demonstrate this. If you see a doctor and the bill is $100, the first hurdle is whether you have paid your deductible yet or not. If you have paid the deductible amount, the insurance carrier will pick up a portion of the bill and the rest you will owe. If your Co-Insurance is 20%, then you are responsible for 20% of the bill. In this case its $20. If your Co-Insurance is 35%, then you are responsible for $35. The higher the co-insurance, the more money you will have to kick in for medical services.

Out of Pocket Maximum- this is the amount of money in a given YEAR, that you will likely need to pay on top of health insurance. Some plans include your deductible towards this amount. Some do not. The other fine detail here is that your insurance carrier can deem certain services not included in this out of pocket maximum. For example, if you really hurt your knee and need an MRI, your insurance carrier can say that the MRI is not a covered service meaning that they will not pay for it. The MRI bill will come to you on top of all the other bills that you have accrued.

IN- Network/ OUT of Network- This seems to be the area of most confusion for most patients. The simplest analogy I use is to think of discount membership stores like Costco or Sam’s Club. When you have a membership to either place, the products they sell have been approved by Costco or Sam’s, at an agreed price, and then the you the consumer can purchase it from the store, typically at a discounted rate. If a product that you want is not at Costco or Sam’s, then you are going to pay full price at another store. IN- network means that the doctors office has agreed to terms set by the insurance carrier, and you the patient only pay a pre-determined amount of money based on these negotiations. Most times- your charge is a nominal fee. OUT of network means that your doctors office is NOT a part of the insurance plan. The fees associated with this visit are ultimately your responsibility and sometimes your insurance carrier pays you back for services rendered. NEVER assume that your doctors office is IN NETWORK. I always assume OUT of network coverage until I see it in writing.

Co-Pay- The amount of money that you must pay at the doctors office. Think of this as an entry fee. Primary care doctors have a low copay. Specialty doctors and the Emergency Room have high Copays. The copay is devised as a financial barrier. The insurance company and the medical practice wants to make sure that you the patient are coming in for something truly medical related. You would be surprised at how many people that have $0 co-pays come to the doctor for a hang nail, or non medical related issues. It’s a way of allocating resources as well. For every hang nail, there is also a sick patient that may have not been seen. Some patients have commented to me about copays in the past, thinking that this money goes straight into our pockets as supplementary income. Rest assured, I tell them, the amount of money collected barely covers the electricity bill.

So in essence, the question I hope that many of you are asking yourselves, is what’s the point health insurance? It does not provide any health benefits. There seems just to be layers of payment schemes. So why get health insurance? You need to start thinking of health insurance like car insurance. Most of us get car insurance to help protect us from financial woes if we total our car or get into a serious car accident. It offers a layer of financial protection for us. We still get our oil changed, brakes fixed, tires rotated, get our maintenance done at our own expense. This is how I view health insurance. It’s there to help pay for medical services if you should get really sick or really hurt. It will offset a majority of costs that you may have been responsible for. In the event of a serious accident or surgery like appendicitis, those with high deductible insurance plans will burn through the deductible within hours of such an event. It will offset the bill of $20-30K coming to greet you 30 days later.

The last point I will leave you with came out of a patient conversation this past week. There is a perception out there that doctors receive discounted rates for our own healthcare insurance and coverages. The assumption is based on the fact that since we are in the medical arena, that insurance carriers cut doctors a break. Nothing could be farther from the truth. For years, I paid, through my former group, $6000 per year ($500/month) for my own health insurance, something I rarely used. I was not given a higher level of coverage than any of my staff. The only difference is that I also was responsible for paying for their premiums as well. Realizing over time at my cost for this, I switched myself to a high deductible insurance plan with an HSA (health savings account). The HSA or health savings account is a tax deferred account where I can set money aside for any medical needs, separate from any bank or retirement account. For me, this was the most cost effective solution. This coupled with a subscription pay primary care group such as Flat Rock Health Seattle covers all my bases for health, wellness, and serious injuries.

Now that you are empowered with this terminology, I hope that each and everyone of you will understand some of the insurance company jargon. I hope that this will allow you the ability to make informed decisions for you and your family regarding your safety net (health insurance).

International Health Insurance Coverage for Travelers

International health insurance coverage is a project design to protect your health, your belongings and your financial investments when making a trip. It also provides peace of mind to you and your family while on vacation. Taking out international health insurance, be it for business or pleasure, while traveling abroad is a good idea, though not compulsory, most travel operators do insist on some kind of insurance as part of their holiday product. This Insurance product is specially designed to protect you when traveling abroad. Many people only think of small things that don’t really matters a lot like, loss of money or having their luggage stolen, forgetting the fact that other factors such as illness and accident are the factor which can also be covered by travel insurance. Travel insurance is specially designed to protect and cover you from any possible risk you may encounter when traveling abroad. it is for great importance for any one traveling abroad, especially if the need arises for you to pay for any medical expenses that may arise.

How is travel insurance related to international health insurance?

International health insurance coverage offer travelers the opportunity to get cover against any emergency and difficulties they make encounter while traveling outside the country and also having an international health insurance coverage give you a peace of mind because you know that you are cover incase of emergency that may occur while traveling and also there are thing that may go wrong for instance a travel insurance policy can be helpful your flight has been cancelled or you luggage got lost and you need it back very sooner you passport and wallet are stolen on your first trip outside the country these are some of the terrible difficulties that you make encounter and also the health insurance cover all these situation. When choosing a travel insurance coverage you need to carefully consider the level of coverage that you want and the cost of the policy, you need to make sure that the travel insurance coverage covers personal belongings and money, medical expenses, legal expenses, personal liability and also personal accident and also you need to different form of travel insurance policy around and also check out their options so as to save a great deal of money for your self.

What is cover that is offered for international health insurance?

International health insurance provide medical insurance for sudden and unexpected injury or illness while traveling international health insurance coverage for travelers care for the unavoidable expenses that could incurred on account of an injury or sickness while traveling. International health insurance plan covers medical expenses, trip cost trip international, travel delay, protection for missed connection trip cost cancellation, Air ticket cover for ticked change costs that are charged by the airlines, it also cover for transportation. International health insurance coverage offers major international health insurance policy that is both renewable annually and for the long-term and also this kind of coverage is available for families, groups and individuals. What father show that travel insurance relates to international health insurance is that both policies provide basic health insurance or medical insurance for individual families against medical emergency at any where you might be either inside or outside the country. Some of the reasons why people are now opting for international travel health insurance is that it provide or covers trip for cancellations that most health insurance like the preferred provider organization and the health maintenance organization do not provide and also most tour operators and cruise firms do not provide refund and they also charge a big penalty for changing tickets.

The international health insurance plan makes provision for all of these situations. There is also the international student health insurance that crucial for obtaining medical services and assistance when they travel abroad while traveling the international student health insurance policy provide smart solution to confront a possible medical emergency and expenses for you to have a proper and comprehensive international student health medical insurance cover, you need to make sure that you have a coverage that provide 24 hour medical emergency assistance, Emergency medical Evacuation, the acts of terrorism, a Repatriation of remains and also the benefits for pre-existing conditions before buying a international student health insurance policy you need to carefully consider if the insurance farm is reliable, and is you are in another country or state will the plan provide for insurance cover and also will the plan along you to choose you own doctor. Taking the international health insurance plan, while you travel around your country or travel abroad, the International health insurance coverage is provide to face unforeseen circumstances. So before traveling it will be sensible to buy an affordable and comprehensive travel insurance policy to overcome any financial constraints arising from a medical emergency.

The Scary Truth Behind Health Insurance Applications

In present times, insurance buyers may easily obtain health insurance applications. As many health insurance companies and brokers have established their own official web sites over the Internet, it is possible to get health insurance applications with a single mouse click. Alternatively, insurance buyers can get the health insurance applications offline, as well.

Insurance buyers may wonder how and where to apply for health insurance coverage, but be cautious, as an application is a later stage in the approval process of health insurance.

Before sitting down to fill up health insurance applications, insurance buyers need to collect information that is likely to help in filling up health insurance applications. These include names and residential address of physicians, dates of recent visits, and some details of recent insurance coverage.

How to apply for health Insurance Coverage:

It is wise to apply through an employer. If insurance buyers apply through their employer for health insurance coverage, they certainly do not need to submit a medical report. However, they have to wait for the firm’s next enrollment period before applying. For a new employee, it may take a long time for approval.

The application process to join a group health coverage is simple, since most insurance coverage may sign up everyone irrespective of previous and present health state.

For instant approval of health insurance coverage, people need to fill up the application form with certain information. This includes information such as name, residential address, social security number, description of the insured and dependents (together with names, date of birth, age, social security number of all dependents), and employment details such as date of appointment and kind of intended health insurance plan. At times, health insurance companies may ask for any previous health insurance policies, including policy numbers and insurers.

Once buyers fill up all necessary details, the completed application form goes to the insurer, where coordinators are present to process and approve it. Once coordinators feel that all details are up to par, they recommend approval of health issuance coverage for applicants. Hence, it is always best to fill up the application form with correct information.

If buyers wish to apply for group insurance coverage, procedures are similar. However, in such cases, applicants need to manage all paper work themselves. A few insurance companies send insurance agents to negotiate and help in the application process of health insurance approval. The agents help to gather all required documentation, organize an in-home medical test, and collect a pre-payment check.


The online process of health coverage approval is so simple that many insurance buyers decide to apply online. To do so, insurance buyers need to visit the health insurance firms’ web sites, wherein they will find an application form.

Just enter the same information as in an offline application form, and click on submit. The system accepts the form automatically.

Health insurance applications are really simple, fast and reliable. However, if buyers feel uncomfortable in providing confidential information on the Internet, it is a good idea to apply through off-line mode.