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Important Health Insurance Terms To Know

Important Health Insurance Terms To Know


Health insurance is complicated; there is no doubt about that. While it is

difficult to absorb all the details of your health policy, there are a few terms

you should familiarize yourself with to make it easier to read and understand

your policy. These basic terms will help you to shop for and make sense of

your health coverage, so take a minute to learn and understand them.


Co-insurance And Copay

This is the amount you are expected to pay when you visit a doctor, go to

urgent care, or to the emergency room. These terms are often used

interchangeably, but they are a little different.

There are usually four different co-pay amounts for four separate types of

doctor visits. The lowest co-pay is generally the one you pay to visit your

regular doctor, pediatrician, or obstetrician. Often, a slightly higher co-pay is

charged for a visit to a specialist. This can include specialties such as

dermatology, ear, nose and throat (ENT) specialists, surgeons, and many

more. Finally, there are usually two set co-pay amounts for either an urgent

care or emergency room visit. Emergency room visits usually carry the

highest co-pay amount.

Co-insurance usually refers to a percentage of the total cost that you are

required to pay, especially for more unusual treatments and tests.



Much like your auto insurance, a health care deductible is the amount you

are expected to pay before your benefits kick in. Co-insurance amounts do

not usually count toward fulfilling your deductible requirements. In most

cases, regular office visits also won’t be charged toward your deductible.

Things like lab work, medical tests, and hospital visits are the types of costs

that will count toward your deductible. Once you have paid out the full

amount of the deductible, your policy will cover everything else at the set


If you have other family members on your policy, you may have two

deductible amounts—one per individual and one per family. Once the family

limit is met, no further deductible payments are required.


Out Of Pocket Limit

Most insurance policies carry a yearly out of pocket limit; this means that

there is a limited amount of money you will have to pay out of pocket in that

year. After this limit is reached for the year, insurance will cover the rest of

your medical care in full. This limit protects you in the event of a serious

illness or injury that results in a lot of medical bills.

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