Kentucky Individual Health Insurance - Understand the Lingo

When you are shopping for Kentucky individual health insurance, you could come across many terms and expressions. Understanding the lingo is the first step towards finding a plan that meets your needs.

Important Health Insurance Terms

Premium: This is the amount you have to pay the insurance company every month when you purchase a Kentucky individual health insurance policy. If you choose a plan with a lower premium and higher deductible, this would mean you save money now. A higher premium/lower deductible plan helps you face unexpected medical expenses later and face rising healthcare costs. Remember that non-payment of your premium can result in the cancellation of your policy.

Copayment: Your copayment or copay is the amount that you have to pay up front for a specific type of service, in addition to what your insurance covers. For instance, your Kentucky health insurance plan may require a $10 copay for each office visit. The insurance company pays the rest of the charges. If you expect to make frequent doctor office visits, it’s advisable to choose a plan with an affordable copay.

Deductible: The deductible is the amount you may be required pay out-of-pocket before your insurance company covers the costs. Most often, your monthly premiums and copays will not count toward your deductible. A good rule is to keep your deductible at a level that is not higher than about 5% of your gross annual income.

Coinsurance: This is the money that you have to pay for services, after your deductible has been met. Co-insurance is usually specified by a percentage. For example, if your insurance company covers 80% of your x-ray charges, you would have to pay the remaining 20% even after your annual deductible has been met. This 20% is your coinsurance.

Out-of-pocket maximum: When you are buying your Kentucky health insurance policy, pay special attention to its out-of-pocket maximum. This is the maximum amount (through deductibles, copays or coinsurance) that you must pay out of pocket. Once you have paid this amount, the insurer will pay in full for your health care expenses for that year. Your monthly premium will not count towards meeting the maximum out of pocket costs.

Claim: The claim is the request or application that you or your health care service provider makes to your Kentucky health insurance company for the company to pay for the benefits of the plan. The insurer may or may not approve the claim, based on their evaluation of the situation.

Maximum dollar limit: This is the maximum amount of money that your insurance company will pay for your claim within a specific time period. This amount could vary based types of illnesses or types of services, and whether they are specified for a year or for a lifetime.

Effective date: This is the date on which your insurance coverage begins.

Get Professional Guidance

This is just some of the basic health insurance lingo. There is so much more you need to know – more term, types of Kentucky individual health insurance plans available, how to go about getting quotes and comparing them, and selecting an affordable plan to meet your requirements. Contact an experienced, licensed Kentucky health insurance broker for professional guidance.