Help me understand what this means…A Brief Look at Health Insurance Terms


Health Insurance can be complicated.  We make it simple to get along with.

Part of that simplicity needs to be developing a solid understanding of the terminology within the health insurance policy.  Here are a couple common terms that it is helpful to understand when evaluating your insurance options.  Our agents will always discuss any questions, the following is meant to augment good conversations rather than replace them.

  • Premium – monthly payment to the insurance company for them to share in the risk of paying for health care
  • Deductible – amount that the insured is responsible to pay for medical care (only refers to deductible eligible expenses)
  • Copayment – payment made, typically at the point of care, by the insured in consideration for services rendered
  • Co-Insurance – the sharing of medical expenses between the insured and the insurance carrier once the deductible has been met
  • Maximum Out of Pocket (MOOP) – the most that an insured will pay, excluding premiums, for medical care in a given plan year
  • Essential Health Benefits – the set of benefits that is required by the Affordable Care Act to have some level of coverage in every insurance plan
  • Minimum Essential Coverage – the coverage that’s required to meet the individual mandate from the Affordable Care Act.  Coverage from an individual policy or group policy can satisfy this requirement.

This list is nowhere from exhaustive, it’s just a good starting point.  There are other important concepts and ideas with which you may need to be familiar, and we would love to discuss those in detail with you.

If you have questions or would like to continue this conversation, please give us a call at 717.637.3670 or submit our contact form.

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