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Archive for the ‘Health Insurance Terms’ Category

Health Insurance- Common terms and definitions

Friday, July 19th, 2013

Health insurance can seem a bit overwhelming, so we thought a few terms defined might be helpful as you consider your current policy or look to purchase a new one!

Coinsurance is the percentage of covered medical expenses that you pay after you’ve met your deductible. Coinsurance is usually listed as a percentage. For example, if your plan lists coinsurance at 20% of covered medical expenses after you’ve met your deductible, then the plan pays 80% of covered services, and you pay 20% until you reach your coinsurance maximum.Coinsurance maximum The coinsurance maximum is the total amount of coinsurance that you’re required to pay for covered medical services in a plan year. Once you reach the coinsurance maximum, your plan usually covers 100% of all covered services for the remainder of the benefit period. Under a traditional health plan, you would continue to pay any copayments for covered services, such as office visits or prescription drugs. Under a high-deductible health plan, your covered medical services would be paid 100%.

Out-of-pocket maximum

Your out-of-pocket maximum is the maximum amount you would be required to pay in a plan year for covered medical expenses. With a high-deductible health plan, this amount is usually the total of your deductible plus your coinsurance maximum. Knowing the definitions of some common terms associated with health insurance may help you make better decisions about choosing a plan that’s right for you.

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What is Coinsurance?

Sunday, October 24th, 2010

Many BCBSNC applicants ask the question…. What is coinsurance?  BCBSNC defines coinsurance as “the percentage of the allowed amounts for covered services that BCBSNC will pay after you meet your deductible.”  In other words, it is the percent that the insurance company is responsible for paying towards your medical bills.  When does coinsurance come into play?  When you have to go into the hospital, have diagnostic testing such as MRIs, CAT Scans, or x-rays, or if you have surgery in a free standing surgery center. 

For more information on health insurance coverage in North Carolina, please visit our website at www.nchealthplans.com or call our toll free number 888-765-5400 and speak with one of our qualified agents.  Our agency provides coverage for health insurance in North Carolina through Blue Cross Blue Shield of North Carolina (BCBSNC).  You may qualify for a 15% healthy lifestyle discount if you are in excellent health.  Call us for details.

Understanding How Insurance Works…

Sunday, February 15th, 2009

Health insurance companies use historical data and analysis to predict the medical expenses for any given group of individuals (usually a company’s employees). The premiums they charge are based on the amount of claims they’ve paid in the past and what they expect future claims to cost. When insurers pay out more in claims than they receive in premiums and when future services are predicted to cost more, premiums go up.

As consumers, we are demanding more medical services than ever before. And the cost of these services is going up. These increased costs are passed on to employers in the form of increased premiums. Insurance companies work with employers to adjust services offered, as well as co-payments and deductibles, to minimize the impact of rising costs.

Take time to understand your health plan — it can help save healthcare dollars for you and for all Americans. For example, many health plans offer a reduced co-pay if you choose FDA-approved generic prescription drugs, so you pay less. Because the average total cost of a generic drug is three times less than the brand name, it helps keep costs down in your health plan.

Understanding the basics of how health insurance works and how to make the most of your own health plan can help keep healthcare affordable for everyone.

The content of this post is from BlueCross BlueShield Association’s article “Coverage Basics: How Health Insurance Works”

For more information on health insurance coverage in North Carolina, please visit our website at www.nchealthplans.com or call our toll free number 888-765-5400 and speak with one of our qualified agents.  Our agency provides coverage for health insurance in North Carolina through Blue Cross Blue Shield of North Carolina (BCBSNC).  You may qualify for a 15% healthy lifestyle discount if you are in excellent health.  Call us for details.

Blue Points for Blue Cross Blue Shield of NC Members

Friday, December 19th, 2008

Blue Points

Earn prizes for taking an active role in your health.
Physical activity can help reduce the risk of cancer, heart disease, diabetes and other health conditions. That’s why we created Blue PointsSM, our physical activity and wellness incentive program available exclusively for BCBSNC members.

Just 30 minutes a day of physical activity or participation in wellness activities earns points toward prizes like electronics, sports equipment, clothing and more!* Collect points and select prizes from our four Blue Points prize levels (B, L, U, and E). Special prizes are available for children ages 6 – 12 through Blue Points for KidsSM.

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Deductibles and Out-of-Pocket Amounts?

Thursday, November 6th, 2008

How do health insurance deductibles and out-of-pocket amounts work?

A deductible is the amount you must pay before the insurance company begins to pay any policy benefits. This is usually an annual amount per insured person, per calendar year.  Although typically there will be a maximum amount of deductibles you will have to pay per family in any given year.  For example, if your “per person” deductible is $500, and you have five people in your family covered under your health insurance, the maximum “family” deductible is usually three times the individual deductible or $1500.00 in this example.  Once three individuals have paid the $500 deductible, no more deductibles will apply to any member of the family for the remainder of the year.  (more…)

HIPPA

Thursday, November 6th, 2008

HIPAA: A Federal law passed in 1996 that allows persons to qualify immediately for comparable health insurance coverage when they change their employment or relationships. It also creates the authority to mandate the use of standards for the electronic exchange of health care data; to specify what medical and administrative code sets should be used within those standards; to require the use of national identification systems for health care patients, providers, payers (or plans), and employers (or sponsors); and to specify the types of measures required to protect the security and privacy of personally identifiable health care. Full name is “The Health Insurance Portability and Accountability Act of 1996.”

For more information on health insurance coverage in North Carolina, please visit our website at www.nchealthplans.com or call our toll free number 888-765-5400 and speak with one of our qualified agents.  Our agency provides coverage for health insurance in North Carolina through Blue Cross Blue Shield of North Carolina (BCBSNC).  You may qualify for a 15% healthy lifestyle discount if you are in excellent health.  Call us for details.

PRIOR INSURANCE COVERAGE

Thursday, November 6th, 2008

Credit for Prior Coverage: This is something that may or may not apply when you switch employers or insurance plans. A pre-existing condition waiting period met under while you were under an employer’s (qualifying) coverage can be honored by your new plan, if any interruption in the coverage between the two plans meets state guidelines.  Letters of creditable coverage are sent from previous insurance companies to the previously insured.  Newly enrolled customers for BCBSNC can fax their letters of creditable coverage to 919-765-7149.

For more information on health insurance coverage in North Carolina, please visit our website at www.nchealthplans.com or call our toll free number 888-765-5400 and speak with one of our qualified agents.  Our agency provides coverage for health insurance in North Carolina through Blue Cross Blue Shield of North Carolina (BCBSNC).  You may qualify for a 15% healthy lifestyle discount if you are in excellent health.  Call us for details.

Network, In-Network, and Out-Patient

Thursday, November 6th, 2008

 

Network: A group of doctors, hospitals and other health care providers contracted to provide services to insurance companies customers for less than their usual fees. Provider networks can cover a large geographic market or a wide range of health care services. Insured individuals typically pay less for using a network provider.

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EOBs, COBRA, Waiting Period and Lifetime Maximum

Thursday, November 6th, 2008

Explanation of Benefits: The insurance company’s written explanation to a claim, showing what they paid and what the client must pay. Sometimes accompanied by a benefits check.

COBRA: Federal legislation that lets you, if you work for an insured employer group of 20 or more employees, continue to purchase health insurance for up to 18 months if you lose your job or your coverage is otherwise terminated. For more information, visit the Department of Labor.

Waiting Period

This is the time one would have to wait until certain health insurance coverages are available.

Lifetime Maximum

This is the most amount of money the health insurance policy will pay for the entire life. Pay attention to individual lifetime maximums and family lifetime maximums as they can be different.

For more information on health insurance coverage in North Carolina, please visit our website at www.nchealthplans.com or call our toll free number 888-765-5400 and speak with one of our qualified agents.  Our agency provides coverage for health insurance in North Carolina through Blue Cross Blue Shield of North Carolina (BCBSNC).  You may qualify for a 15% healthy lifestyle discount if you are in excellent health.  Call us for details.

PRE EXISTING CONDITIONS

Wednesday, November 5th, 2008

Pre-Existing Conditions

A pre-existing condition is a medical condition diagnosed or treated before joining a new plan. In the past, health care given for a pre-existing condition often has not been covered for someone who joins a new plan until after a waiting period.

Under the law, most of which goes into effect on July 1, 1997, a pre-existing condition will be covered without a waiting period when you join a new group plan if you have been insured the previous 12 months. This means that if you remain insured for 12 months or more, you will be able to go from one job to another, and your pre-existing condition will be covered. without additional waiting periods. even if you have a chronic illness.If you have a pre-existing condition and have not been insured the previous 12 months before joining a new plan, the longest you will have to wait before you are covered for that condition is 12 months.

To find out how this new law affects you, check with either your employer benefits office or your health plan.

For more information on health insurance coverage in North Carolina, please visit our website at www.nchealthplans.com or call our toll free number 888-765-5400 and speak with one of our qualified agents.  Our agency provides coverage for health insurance in North Carolina through Blue Cross Blue Shield of North Carolina (BCBSNC).  You may qualify for a 15% healthy lifestyle discount if you are in excellent health.  Call us for details.