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Top 10 Health Insurance Terms to Know

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When you’re trying to read a new health insurance policy, it can feel as though the insurance company speaks a different language. To a degree, the insurance industry does use terminology exclusive to the field. Before you begin wading through your insurance forms, consider reviewing the top 10 health insurance terms to know to give you a solid foundation of knowledge.

  1. The benefit is the amount the insurance company will pay to you, your doctor or a medical facility in the event of a particular illness or situation.
  2. A claim is a request you or your care provider file with the health insurance company for payment or reimbursement for medical treatment.
  3. The co-payment is the flat fee you pay for prescriptions, doctor visits, emergency care and operations.
  4. Your deductible is the amount of money you must pay before your health insurance company begins to cover your medical expenses.
  5. A major medical policy usually has a higher than normal deductible, but comes with a high coverage limit to cover catastrophic and expensive medical situations.
  6. Medigap insurance policies help individuals on Medicare or Medicaid afford treatments and prescriptions the government does not cover, or does not fully cover.
  7. Your network is the group of doctors, specialists, hospitals and other medical facilities that are under contract to accept your insurance and charge set rates for your care.
  8. If you reach the out-of-pocket maximum for your health insurance policy, your insurance company will begin paying 100 percent of your medical expenses, subject to their terms and conditions.
  9. A policy rider is an additional or supplemental modification to your health insurance policy, usually include or exclude medical situations that the existing insurance contract does not cover.
  10. During the waiting period, your health insurance will not pay any claims due to illness because your coverage is not yet official.

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