Understanding Your Health Plan
Healthcare doesn’t have to be confusing. The following resources and tools were made for you to understand all those strange-sounding terms and find out what your plan includes, what services it covers and how much things will cost you:
- Common terms and costs.
- Example of common payments and how they work.
- Out-of-pocket maximums.
- Preventive vs. diagnostic services.
- And more helpful resources.
Scroll down to discover resources made just for you. With this information in hand, you’ll feel newly empowered to take the best care of your health. And remember, we’re always just a phone call away. If you have any questions, you can reach us at the number on the back of your health plan ID card.
Common Terms and Costs Video
Common Terms and Costs
We know health plans can be confusing – especially all those strange-sounding terms and knowing how much you might have to pay for certain things. Here’s a quick list of key terms to know. For more about these – or if you have any questions – give us a call at the number on the back of your health plan ID card. We’re always here to help.
- Premium: The monthly amount you pay to be on our plan.
- Benefits: The healthcare services your health plan covers: doctor visits, routine physicals, diagnostic tests, etc.
- Out-of-Pocket Costs: Although your plan covers these benefits, you still have to pay some or all of the costs for many of them. Out-of-pocket costs are the costs you (rather than your health plan) pay. These can include:
- Deductible: A set amount you pay before your plan starts helping pay for your medical care or pharmacy benefits. Some plans have separate medical and pharmacy deductibles.**
- Copay: The fixed dollar amount you pay for services at a doctor's office, pharmacy or hospital.
- Coinsurance: The percentage you pay for services at a doctor's office, pharmacy or hospital.
- Out-of-Pocket Maximum: After you pay this amount in combined out-of-pocket costs throughout the year, your plan pays 100% of covered expenses for the rest of the year.
** You no longer have to pay copays or coinsurance, just your monthly premium.
Preventive vs Diagnostic Services Video
More Resources
*All plans are different. Call the number on the back of your health plan ID card for information about your plan’s specific benefits, coverage, costs and maximums.
**Not all plans cover a full year, and not all begin in January and end in December. Call the number on the back of your health plan ID card for information about your plan’s specific benefit period.