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Health Insurance

Your health benefits will vary depending on what you are willing to spend for a quality physician network with a resonable deductible.

 Your Health

Health insurance protects you and your loved ones against the risk of incurring substantial medical expenses. Benefits are administered by a central organization such as a government agency, private business, or not-for-profit entity. Your own health is the most important asset you can insure, and the cost of healthcare in the US will continue to increase due to the implementation of the Affordable Care Act of 2010.

Proper health insurance planning is not only essential for families and businesses, it is also required by federal law. We help you understand what the various health insurers offer and how to choose the best plans with the strongest networks that will meet your health needs.

How it works

A health insurance policy is a contract between an insurance company and an individual or an individual’s employer. This contract is renewable annually, with all obligations starting over January 1st of each year. The type and amount of healthcare costs that will be covered by the health insurance company are specified in advance, in the contract’s "Schedule of Benefits" section. The individually insured person’s obligations are the following:

Monthly Premium: The amount the individual or the individual’s employer pays to the health insurer to purchase health coverage. There cannot be more than 35 day lapse between premium payments, otherwise the individual’s policy will lapse due to nonpayment of premium.

Deductible: The amount that the individual must pay out-of-pocket before the health insurer pays its share. For example, you might have to pay a $500 deductible per year, before any of your health care is covered by the health insurer. It may take several doctor’s visits, diagnostic tests, or prescription refills before you reach the deductible and the insurance company starts to pay for care.

Co-payment: The amount that the individual must pay out of pocket before the health insurer pays for a particular visit or service. For example, an individual might pay a $25 co-payment for a primary care doctor’s visit, or to obtain a prescription. A co-payment to the health provider must be paid each time a particular service is rendered.

Coinsurance: Instead of, or in addition to, paying a fixed amount up front (a co-payment), the co-insurance is a percentage of the total cost an individual may also pay. For example, you might have to pay 20% of the cost of a surgery over and above a co-payment, while the insurance company pays the other 80%. If there is an upper limit on coinsurance, the policy-holder could end up owing very little, or a great deal, depending on the actual costs of the services they obtain.

MOOP: The maximum out-of-pocket costs that an individual will spend on health care services in a calander year. This includes all your deductibles, co-pays, and co-insurance, but NOT your monthly insurance premiums. Once your healthcare spending hits the MOOP for the calendar year, your insurer picks up the tab, no matter how much it is.

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