Terms to know when it comes to benefits, coverage and insurance.

Part of what makes the Healthcare industry so confusing is all the jargon and terminology. So as our goal is to clear the confusion, we take to our Instagram stories regularly, asking our followers what terms leave them scratching their heads. We do much more than just answering questions on our stories, so if you aren’t already following us, check out @healtheebyhbg on Instagram. We have compiled a few terms and their definitions into one place for those of you looking for clarification. 

Premium is the amount you must pay your insurance company for coverage. This amount is determined based on various factors depending on the type of insurance you purchase. For example, what’s impacting your car insurance premium will be different from your medical insurance. A general rule of thumb for most health-related insurance plans is these five main factors; age, tobacco use, location, type of plan, and the number of people the plan covers. With HealthEE by HBG, you pay this monthly or quarterly.

Prior Authorization, otherwise known as preauthorization and pre certification, is a requirement by health plans for the patient (you) to obtain approval for a health care service or medication before it can be provided. This occurs when the insurer wants to evaluate whether or not the care is medically necessary.  

Policy vs. plans– the insurance policy is the set of rules in place regarding the limits and regulations of your coverage. The insurance plan is the roadmap for your health, considering the policy. In other words, the policy affects what is available within your plan. 

The deductible is the amount you pay before your insurance company steps in. This amount is dwindled by your premium payments. Once you pay the deductible amount through your premium payments or paying for doctor’s visits, your insurance company steps in. A low deductible means your premium prices will be higher, but chances are you will meet your deductible quicker, whereas a high deductible will lower your premium payments. If you don’t go to the doctor, this could be the right choice for you; however, in the case of an emergency, you may be footing the bill on your own.

An IUA or initial uninsurable amount 

An IUA is an amount you pay per a specific medical event before your expenses become sharable. For example, our Common Sense health share plans which can be found here, have IUAs that members are responsible for paying – but have no deductibles.

We could write a novel with how many terms exist within Healthcare and insurance, but we hope these terms bring clarity to your relationship with your coverage. Suppose you have further questions or other phrases you would like clarified. In that case, our Ask Evan advisory team is made up of real people at your disposal to answer questions, provide support, and give you coverage and confidence on your benefit purchasing journey. Click here to schedule a free, noncommittal call with an advisor today.