Key Insurance Terminology Definitions made simple.

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Key Insurance Terminology Definitions

Quick and simple resources for a busy enrollment period from

Premium The monthly fee charged to keep your policy active.
Co-pay A flat rate you’ll pay for a specific service such as a doctor’s visit or prescription benefit.
Coinsurance An additional patient expense. It is over the deductible that is included with some plans.
**For example, with 20% coinsurance, you would pay $1,000 for every $4,000 paid by your insurance company.
Out of pocket maximum The maximum amount an individual or family would be required to pay annually through deductibles and/or coinsurance.

**In 2018, the ACA out-of-pocket maximum was $7,900 for individuals and $15,800 for family coverage.

Lifetime Maximum Benefit The max dollar amount an insurance company will pay out during your lifetime on a short-term insurance plan for non-essential healthcare services.
 Chronic Conditions A chronic condition is a syndrome, physical impairment, disability or disease state that is persistent or otherwise long-lasting in its effects, or a disease that comes with time.

Common chronic diseases include arthritis, asthma, cancer, COPD, diabetes, hepatitis C and HIV/AIDS.

Pre-existing Conditions A pre-existing condition is any medical condition the patient has already received medical advice or treatment for prior to enrollment in a new insurance plan.
Underwritten Policies With underwritten policies, you are subjected to a health background check by the insurance company. Chronic conditions typically exclude you from getting coverage or are not covered by underwritten insurance plans. However, pre-existing conditions that are chronic (like a knee or back injury that happened earlier and is no longer a problem) usually won’t prevent you from getting covered and often will be covered if the injury reoccurs.
Guaranteed Issue ACA Policies ACA policies are guaranteed, in that insurers are required to offer coverage to all applicants. Sex, age, economic status, or pre-existing condition is a reason for rejection.

Healthcare Sharing Services are also guaranteed coverage, so long as the applicant confirms that they share the groups beliefs. With the exception of some states, guaranteed issue doesn’t limit how much you can be charged if you enroll. Refer to state in question market place site for more information specific to zip code.

Guaranteed Issue ACA Alternative Policies In most instances, short-term medical, GAP, indemnity and association- based coverage will enroll you even with a pre-existing chronic condition. The condition likely will not be covered. Some instances, you may be charged more if you have a pre-existing condition.


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