The Basics
The fixed amount you pay each month to keep your health insurance policy active, whether you go to the doctor or not.
What is a premium?
An acronym for a popular managed care plan where you must use a network of doctors.
What is an HMO (Health Maintenance Organization)?
The official document or statement mailed by your insurance company that explains what medical treatments and services were paid for.
What is an EOB (explanation of benefits)?
The federal government health insurance program primarily designed for individuals aged 65 and older.
What is Medicare?
The year I got my Life, Accident, and Health license and began my career.
What is 2002?
The specific amount of money you must pay out-of-pocket for covered medical services before your insurance plan starts paying.
What is a deductible?
A health plan that allows you to see out-of-network doctors, but charges you much higher out-of-pocket costs for doing so.
What is a PPO (preferred Provider Organization)?
The requirement that your doctor must get approval from the insurance company before they will cover a specific procedure or medication.
What is a pre-authorization or a prior authorization?
The joint federal and state program that provides comprehensive health coverage for individuals and families with low incomes.
What is Medicaid?
The age of clients in my target market.
What is all ages or what is 0-100?
A flat, upfront fee you pay for a specific medical service, such as a $20 charge for a primary care visit.
What is a co-pay?
A high deductible health insurance plan that may give you the option to set up a tax advantaged account savings account?
What is an HSA (health savings account) eligible plan?
The official list of prescription drugs that your insurance plan has agreed to cover.
what is the formulary?
A government-regulated platform where individuals can shop for and purchase standardized health insurance plans, often qualifying for federal subsidies.
What is the Health Insurance Marketplace (or Exchange)?
The state I moved to for a year and a half and where my middle child was born.
What is Maryland?
The percentage of costs you pay for a covered medical service (e.g., 20%) after you have met your deductible.
What is coinsurance?
A plan in which members can seek care inside the network or go outside the network directly to preferred providers.
What is a POS (point of service plan)?
The maximum amount you will have to pay out-of-pocket for covered services in a plan year, after which the plan pays 100%.
what is the out-of-pocket Maximum (or MOOP - Maximum out-of-pocket)?
A specific life event—such as getting married, losing a job, or having a baby—that allows you to change your insurance outside of the standard enrollment period.
What is a special enrollment period (or SEP)?
Or what is a qualifying event?
Where I received my BA.
What is Wofford?
The doctor who coordinates your medical care
What is a primary care doctor or PCP?
Typically paid regardless of whether the provider is in-network.
What is an emergency?
A condition that you have been or should have been treated for in the last 12-24 months.
What is a pre-existing condition?
A high deductible health insurance plan may allow you to set up a tax advantaged savings account that can be used for medical expenses.
What is an HSA or Health Savings Account?
My 5 seconds of fame
What is the Hootie and the Blowfish video "Hold my Hand"?