Common Insurance Terms

Common Insurance Terminology

Common Terms

Co-Pay

A fixed amount (for example, $15) you pay for a covered healthcare service, usually when you get the service. The amount can vary by the type of covered healthcare service.

 

Deductible

The amount you owe for covered healthcare services before your health insurance plan begins to pay.

 

Co-Insurance

Your share of the costs of a covered healthcare service, calculated as a percentage (for example, 20%) of the allowed amount for the service. You pay co-insurance after you’ve met your deductible. For example, if the health insurance plan’s allowed amount for an office visit is $100 and you’ve met your deductible, your 20% co-insurance payment would be $20. The health insurance plan pays the rest.

 

Maximum Out of Pocket

The most you pay during a policy period (usually one year) before your health insurance or plan starts to pay 100% for covered essential health benefits. This limit must include deductibles, co-insurance, co-payments, or similar charges and any other expenditure required of an individual which is a qualified medical expense for the essential health benefits. This limit does not have to count premiums, balance billing amounts for non-network providers and other out-of-network cost-sharing, or spending for non-essential health benefits.

 

Premium

The amount that must be paid for your health insurance or plan. You and/or your employer usually pay it monthly, quarterly or yearly.

 

Dependents

A child or other individual for whom a parent, relative, or other person may claim a personal exemption tax deduction. Under the Affordable Care Act, individuals may be able to claim a premium tax credit to help cover the cost of coverage for themselves and their dependents.

 

 

Types of coverage

In the new health insurance market, each plan is categorized by its “actuarial value”, the share of health care expenses the plan will cover. Bronze plans are less generous toward the consumer, meaning the consumer will pay more out of pocket than a Silver and a Gold. However, they will also have a lower monthly premium. There is no “one size fits all”, it is important for you to find your comfort level.

 

Gold

Plan Covers 80%

You Pay 20%

 

Silver

Plan Covers 70%

You Pay 30%

 

Bronze

Plan Covers 60%

You Pay 40%

 

Catastrophic

Plan Covers Less Than 60%

 

Contact: Jennifer Mauldin, Mauldin Insurance Group, Lexington, SC  843-509-2462