Q1. What is HIPAA?
Answer: HIPAA stands for the Health Insurance Portability and Accountability Act, which is a law mandating that anyone belonging to a group health insurance plan must be allowed to purchase health insurance within an interval of time beginning when the previous coverage is lost regardless of current health status.
Q2. What is a network?
Answer: A network is a list of doctors, hospitals and other providers that have contracted, or agreed, with an insurance company to do business with the insurance company. The provider’s fees have been pre-negotiated, which means that the insurance company will not necessarily pay the doctor or hospital what your actual medical bills are, but will pay a lower amount.
Q3. What is “Out-of-Pocket-Maximum”?
Answer: This is the amount of money one would pay out of their own pocket towards your medical expenses in any given year. An out of pocket expense can refer to how much the co-payment, coinsurance, or deductible is. Also, when the term annual out-of-pocket maximum is used, that is referring to how much the insured would have to pay for the whole year out of their pocket, excluding premiums. Usually, your maximum out-of-pocket is never more than a couple of thousand dollars over and above your chosen deductible.
Q4. What’s the difference between a Primary Care Physician (PCP) and a specialist?
Answer: A Primary Care Physician, or PCP, is the doctor you would go to on a regular basis, such as when you’re simply not feeling well, or have an ear ache or the flu. A specialist is a doctor that your PCP might refer you to if the problem you have requires a doctor with more experience in a certain area.
Q5. What are co-pays?
Answer: A co-payment or co-pay is a specific flat fee you pay for each medical service, such as $30 for an office visit, after which the insurance company often pays the remainder of the covered medical charges
Q6. What is coinsurance?
Answer: Coinsurance is a cost-sharing requirement where you are responsible for paying a certain percentage and the insurance company will pay the remaining percentage of the covered medical expenses after your plan deductible is met.
Q7. What is a deductible and how does it work?
Answer: A deductible is the amount of money you must pay each year before your health insurance plan starts to pay for covered medical expenses.