Just as with other types of insurance policies, health insurance has its own terms and lingo to describe certain elements of payments and coverage. Of course, California health insurance is no different. Here are explanations of some common terms to help you better understand your health insurance policy.
Â Exclusions: In your Description of Coverage (DOC), exclusions are services that the insurance policy will not pay for.
Â Co-payment: This is a payment you make alongside your health insurance provider when paying for health care. For example, you may be required to pay a $20 co-payment for a doctorâ€™s appointment. Even though the full cost of the appointment is $100, you only pay the co-payment, while the insurance pays for the rest.
Â Coverage limits: This defines the payment obligations of the insurance policy. Some policies only pay for treatment and services up to a certain amount. Policies can have different coverage limits that apply to either certain services or certain amounts of time (e.g. health insurance policies that have an annual coverage limit). If you are purchasing a policy that has coverage limits, make sure itâ€™s a limit that you feel secure with.
Â Out-of-pocket maximums: Like an opposite of the coverage limit, the out-of-pocket maximum dictates the most a policyholder will have to pay for any service. Once the out-of-pocket maximum is reached, the health insurance policy will cover the remaining costs.
Â In-Network Provider: Itâ€™s common practice for health insurance companies to compile a list of healthcare providers into a policy network. By seeing an in-network provider, a policyholder can take advantage of lower costs that have been pre-arranged between the insurer and healthcare provider.
Â AIS offers the ability to shop online for health insurance through our partner, Langdon Insurance Services.
Â This content is offered for educational purposes only and does not represent contractual agreements. The definitions, terms and coverages in a given policy may be different than those suggested here and such policy will be governed by the language contained therein. No warranty or appropriateness for a specific purpose is expressed or implied.