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Insurance - Frequently asked Questions
At Integrated we understand that some Insurance 'terms' can be confusing. Our agents work to make sure their clients have a clear understanding of how their policies work. If you need to check on the meaning of a terminology, have questions about a term or need to read something to put you to sleep, below are definitions for insurance terminologies.
What is a deductible?
A deductible is the amount of annual expenses (excluding co-payments) that a policy holder must pay before the plan will begin to cover expenses. For example, if your plan has a $500 deductible, you will pay the first $500 of the expenses before your policy begins paying the expenses.
What is coinsurance?
Coinsurance is the portion of medical costs that are shared by both the insured (the patient) and the insurer. For example, if you have an 80% to $5,000 coinsurance: The insurer is responsible for 80% of the next $5,000 in covered medical expenses. The insured is responsible for 20% of that same $5,000 in covered medical expenses.
What is a co-payment?
A co-payment is a fixed dollar amount you pay for each physician/service visit.
What is Collision coverage?
Collision coverage covers damage to your car in a variety of situations. If you hit another car, the damage to your car would be covered by this part of your policy. For example, if you lose control on an icy road and hit a tree damaging your front bumper, Collision coverage would take care of the repair costs- minus your deductible.
What is a PPO?
A PPO is a health care delivery arrangement that offers insureds access to participating providers at reduced costs. PPOs provide insureds incentives, such as lower deductibles and co-payments, to use providers in the network. Network providers agree to negotiated fees in exchange for their preferred provider status.
What is an HMO?
HMOs are managed care plans that provide care for enrollees by contracting with specific health care providers to provide specified benefits. Many HMOs require enrollees to see a primary care physician (PCP) chosen by the member who will refer them to a specialist if deemed necessary.
HMO plans often do not include deductibles, but co-pays are charged per office. HMO plans typically allow a member to have lower out-of-pocket healthcare costs, but require the member to fore go some choice and flexibility with regard to selecting physicians and hospitals.