We are Vancouver Medicare Experts and we also work with people that need Group Health Insurance (businesses) or Individual Health Insurance.
We get it, Insurance is complicated. Before purchasing any insurance policy, you need to arm yourself with the knowledge and tools required to make informed, confident decisions. And that means understanding the terminology. After all, it’s hard to walk the walk if you can’t talk the talk. Here are some terms to help you understand the technical concepts so you can be confident in your coverage.
A deductible is a predetermined amount of money that the insurer must pay out-of-pocket before the insurance provider pays a claim. Deductibles are essentially your part of the deal. By buying an insurance policy, you are asking the insurer to have your back if anything should go wrong. Sure enough, the insurance company is happy to do this, as long as you agree to cover the first part by paying the deductible.
A co-payment or ‘co-pay’ comes standard with most health insurance policies. It’s a specified out-of-pocket payment that the policyholder must make towards a covered service, usually at the time of receiving the service such as prescription drugs or a doctor visit. Co-payments are fixed dollar amount as opposed to a percentage of the bill.
Usually associated with health insurance, co-insurance is a specified amount, expressed as a percentage, that the policyholder must pay towards a covered service once their deductible has been satisfied. Co-insurance is similar to co-payments, except co-pays require a set dollar amount at the time of receiving the service, as opposed to after.
In-network providers, also known as participating providers, are doctor or hospitals that accept your health insurance plan and have agreed under contract to allow the insurer’s discounted rates. For example, the doctor’s regular fee might be $140, but they’ve decided to accept $90 as payment from patients.
Out-of-network providers are those that don’t participate in your health insurance plan. If you see an out-of-network doctor, you will be responsible for paying the difference between the doctors full charge and your plan’s approved amount. It’s essentially balancing the bill.
Premiums are the amount of money an insurance provider charges, usually on a monthly basis, to provide an insurance policy. The price of an insurance premium can vary and depends on a variety of factors, including but not limited to the level of coverage, the likelihood of a claim being made, the medical history of a policyholder, or the area the person lives or business operates.
This guide is an excellent starting point to grasp the basics of insurance, but for a more in-depth breakdown, please see our glossary page. If you have any questions, please get in touch with us.