INSURANCE 101
Dive into insurance and understand the basics.
Definitions
PREMIUM: The amount paid to an insurance carrier per month to maintain coverage.
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DEDUCTIBLE: The amount the policy owner owes before the policy pays.
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CO-INSURANCE: The percentage of costs that an insured individual or entity is required to pay for covered services or expenses after the deductible has been met.
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CLAIM: A formal request made by a policyholder to an insurance company for compensation or coverage of a loss or damage that is covered under the terms of the insurance policy.
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POLICY OWNER: The individual or entity that holds in the insurance policy and is responsible for paying the premiums. Typically, they're the one who pays the premium payments and holds sole authority to modify the policy.
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HSA: HSA stands for Health Savings Account. An HSA is a tax-advantaged savings account designed for individuals covered under a high-deductible health plan (HDHP)
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NETWORK: The group of healthcare providers and facilities that have contracted with the insurance company to provide health care services.
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BROKER: Professionals that sell insurance and represent the insured.
Open Enrollment
OEP is the period beginning November 1. Individuals can make changes or sign up for health insurance plans without needing a qualifying event!
Time-Limited
Common in Health Insurance and other benefit programs like Medicare and Employer-Sponsored plans
What can you do during OEP?
-Enroll in a new plan
-Switch to a different plan
-Add dependents to plan
-Adjust coverage options
Types of Insurance
GROUP INSURANCE:
TRADITIONAL: Fixed premiums to insurer, insurer bears the risk, simple and predictable. It can be costly with limited control.
LEVEL-FUNDED: Fixed monthly payments, employer assumes some risk, but it's protected by stop-loss coverage. Potential cost savings and greater flexibility.
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LIFE INSURANCE:
WHOLE-LIFE: Lifetime coverage, higher and fixed for life premiums. Death benefits guaranteed as long as premiums are paid.
TERM-LIFE: Fixed term (10, 20, 30 years), generally lower and fixed premiums. Death benefit paid only if insured dies within the term.
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MEDICARE:
MEDICARE ADVANTAGE PLAN: Replaces original medicare, parts A and B. Monthly premiums are often lower. It often includes dental, vision, hearing, etc. Less flexibility due to network rules (HMO/PPO)
MEDICARE SUPPLEMENT PLAN: Supplements original medicare (Parts A & B), has higher premiums, no network restrictions and its usually more flexible.
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INDIVIDUAL HEALTH: UNDER 65
ACA: Plans available through federal or state health insurance and provide guaranteed coverage. They must cover 10 essential health benefits. It has higher premiums, with subsidies available and has year long coverage. It can be restrictive but covers emergency care nationwide.
NON-ACA: Coverage is limited and often excludes major services. Lower premiums with no subsidies but coverage can be denies or charged higher premiums based on health history. Includes temporary covers, usually 3-12 months.
