Your Health Insurance Policy: A Guide To Understanding It

You now are the proud owner of a health insurance policy through your place of employment, but you have no clue what anything in it means. You start reviewing the policy and it gets more confusing as each word is read. This happens too often to a lot of people and it shouldn’t. Insurance policies for the most part are simple to understand if you know the language they speak. Now if you don’t that’s another story. Let’s get started and see if we can help you make sense of your new health insurance policy.

The first things you want to understand are the many terms that are in your policy. One of the common terms that you will see a lot and deal with a lot is a deductible. A deductible is what you would have to pay before any benefits in your health insurance policy would be accessible.  Usually this is an annual amount and will vary greatly by the underwriters of the policy. Most of the time there are separate deductibles for an individual account and a family account. Some policies will let you use some of their services with out meeting the deductible.  Once you meet your deductible then you’re done for that calendar year. The following year though you have to start all over again.

Co-insurance, or co-payments which they are sometimes called, are amounts that are paid by the insured before the insurance will pay and this is in addition to the deductibles. Some policies let you pay a co-payment for certain services without meeting the deductible.

Out of Pocket is what you will have to pay out of your own pocket. This could include your deductibles, co-insurance, and your co-payments. If you hear the term “annual out of pocket expense” this is the maximum out of your own pocket you would have to pay for the services minus the premiums, which are due no matter what.

Most every policy that you get especially health insurance policies have a lifetime maximum term. What this means that your policy basically has a cap on it. During the lifetime you can’t go over a predetermined amount or the health insurance won’t pay after the set amount. Now don’t get worried it’s usually a very high figure but with today’s rapid escalating health care costs you can reach it fairly quickly.

Exclusions will be one section that you must read very carefully and fully understand in your health insurance policy. Exclusions are things the policy will not cover and this can be a very gray area. The policy could cover operations but not after care or cover after care and not the operation. This is one of the most important sections of your policy so read it and reread it over a lot to make sure you grasp all of the contents and what it covers and what it doesn’t cover.

Pre-existing conditions is one of the things you will want to know about. Pre-existing basically means it was a condition you already have and been treated for which the policy will not cover it or pay for any work done for that pre-existing condition.  Some health insurance policies will cover pre-existing where others won’t which is why knowing what is in your policy is very important.

Waiting period is usually the time you will have to wait for your health insurance policy to become effective. Most policies do have a waiting period and the benefits aren’t available until you have met the waiting period requirements. Different companies have different policies so check with your insurance company so you will know the rules for your policy.

Grace period is the amount of time that is given for one to pay their health insurance premium after the original due date has passed.

There are many things that you should always remember as you look over your health insurance policy. Read each and every paragraph and make sure you understand how the whole policy works so you will never be in the dark or have any questions about what is covered and what isn’t.  Remember that it is okay to ask questions!