- Aetna
- Arizona Foundation
- ASPA
- Blue Cross/Blue Shield
- Cigna
- HCA
- HealthNet
- Great West
- Medicare
- Mercy Care
- Phoenix HealthPlan
- United Healthcare
- Schaller Anderson
- more...(call if your plan does not appear on this list)
What is a co-payment?
A "co-payment" or "co-pay" is a specific charge that your health insurance plan may require that you pay for a specific medical service or supply. For example, your health insurance plan may require a $15 co-payment for an office visit or brand-name prescription drug, after which the insurance company often pays the remainder of the charges.
What is a deductible?
A "deductible" is a specific dollar amount that your health insurance company may require that you pay out-of-pocket each year before your health insurance plan begins to make payments for claims. Not all health insurance plans require a deductible. As a general rule (though there are many exceptions), HMO plans typically do not require a deductible, while most Indemnity and PPO plans do.
What is coinsurance?
Coinsurance is the term used by health insurance companies to refer to the amount that you are required to pay for a medical claim, apart from any co-payments or deductible. For example, if your health insurance plan has a 20% coinsurance requirement (and does not have any additional co-payment or deductible requirements), then a $100 medical bill would cost you $20, and the insurance company would pay the remaining $80.
How does an HMO plan work?
Though there are many variations, HMO (Health Maintenance Organizations) plans typically enable members to have lower out-of-pocket healthcare expenses but also offer less flexibility in the choice of physicians or hospital than other health insurance plans. As a member of an HMO, you'll be required to choose a primary care physician (PCP). Your PCP will take care of most of your healthcare needs. Before you can see a specialist, you'll need to obtain a referral from your PCP.
With an HMO you'll likely have coverage for a broader range of preventive healthcare services than you would through another type of plan. You may not be required to pay a deductible before coverage starts and your co-payments will likely be minimal. With an HMO plan, you typically won't have to submit any of your own claims to the insurance company. However, keep in mind that you'll likely have no coverage whatsoever for services rendered by non-network providers or for services rendered without a proper referral from your PCP.
How does a PPO plan work?
As a member of a PPO (Preferred Provider Organization) plan, you'll be encouraged to use the insurance company's network of preferred doctors and hospitals. These healthcare providers have been contracted to provide services to the health insurance plan's members at a discounted rate. You typically won't be required to pick a primary care physician but will be able to see doctors and specialists within the network at your own discretion.
You will probably have an annual deductible to pay before the insurance company starts covering your medical bills. You may also have a co-payment for certain services or be required to cover a certain percentage of the total charges for your medical bills.
With a PPO plan, services rendered by an out-of-network physician are typically covered at a lower percentage than services rendered by a network physician.
How does a POS plan work?
A POS (Point of Service) plan combines some of the features offered by HMO and PPO plans. As with an HMO, members of a POS plan are required to choose a primary care physician (PCP) from the plan's network of providers. Services rendered by your PCP are typically not subject to a deductible. Also, like HMOs, POS plans typically offer coverage for preventive care visits.
Typically, however, you will only receive a higher level of coverage for services rendered or referred by your PCP. Services rendered by a non-network provider may be subject to a deductible and will likely be covered at a lower level. If services are rendered outside of the network, you'll likely have to pay up-front and submit a claim to the insurance company yourself.
How does an HSA work?
Legislation establishing Health Savings Accounts (or "HSAs") took effect on January 1, 2004. HSAs and HSA-eligible health insurance plans are becoming more and more popular. Here are the basics:
An HSA is a tax-favored savings account that may be used in conjunction with an HSA-eligible high deductible health insurance plan to pay for qualifying medical expenses.
Choosing an HSA-eligible health insurance plan may help you save money. Typically, the monthly premium on an HSA-eligible high deductible plan is less expensive than the monthly premium for a lower-deductible health insurance plan.
Contributions to an HSA may be made pre-tax, up to certain annual limits.
Funds in the HSA may be invested at your discretion.
Unused funds remain in the account and accrue interest year-to-year, tax-free.
Copyright © 2008 eHealthInsurance Services, Inc
Download the Following forms for more financial information:
Understanding Medical Bills
Understanding Health Plan Rules
Understanding Health Plan Coverage
Waiting in your doctor's office can make you feel nervous, impatient, or even scared. You might worry about what's wrong with you. You might feel annoyed because you're not getting other things done. Then when you see your doctor or nurse, the visit seems to be so short. You might have only a few minutes to explain your symptoms and concerns. Later that day, you might remember something you forgot to ask. You wonder if your question and its answer matters. Knowing how to talk to your doctor, nurse, or other members of your health care team will help you get the information you need.
Tips: What To Do
List your questions and concerns. Before your appointment, make a list of what you want to ask. When you're in the waiting room, review your list and organize your thoughts. You can share the list with your doctor or nurse.
Describe your symptoms. Say when these problems started. Say how they make you feel. If you know, say what sets them off or triggers them. Say what you've done to feel better.
Give your doctor a list of your medications. Tell what prescription drugs and over-the-counter medicines, vitamins, herbal products, and other supplements you're taking.
Be honest about your diet, physical activity, smoking, alcohol or drug use, and sexual history. Not sharing information with your doctor or nurse can be harmful!
Describe any allergies to drugs, foods, pollen, or other things. Don't forget to mention if you are being treated by other doctors, including mental health professionals.
Talk about sensitive topics. Your doctor or nurse has probably heard it before! Don't leave something out because you're worried about taking up too much time. Be sure to talk about all of your concerns before you leave. If you don't understand the answers your doctor gives you, ask again.
Ask questions about any tests and your test results. Get instructions on what you need to do to get ready for the test(s). Ask if there are any dangers or side effects. Ask how you can learn the test results. Ask how long it will take to get the results.
Ask questions about your condition or illness. If you are diagnosed with a condition, ask your doctor how you can learn more about it. What caused it? Is it permanent? What can you do to help yourself feel better? How can it be treated?
Tell your doctor or nurse if you are pregnant or intend to become pregnant. Some medicines may not
be suitable for you. Other medicines should be used with caution if you are pregnant or about to become pregnant.
Ask your doctor about any treatments he or she recommends. Be sure to ask about all of your options for treatment. Ask how long the treatment will last. Ask if it has any side effects. Ask how much it will cost. Ask if it is covered by your health insurance.
Ask your doctor about any medicines he or she prescribes for you. Make sure you understand how to take your medicine. What should you do if you miss a dose? Are there any foods, drugs, or activities you should avoid when taking the medicine? Is there a generic brand of the drug you can use? You can also ask your pharmacist if a generic drug is available for your medication.
Ask more questions if you don't understand something. If you're not clear about what your doctor or nurse is asking you to do or why, ask to have it explained again.
Bring a family member or trusted friend with you. That person can take notes, offer moral support, and help you remember what was discussed. You can have that person ask questions, too!
Call before your visit to tell them if you have special needs. If you don't speak or understand English well, the office may need to find an interpreter. If you have a disability, ask if they can accommodate you.
Copyright © 2008 womenshealth.gov
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