Health Insurance Frequently Asked Questions

When you are looking for a healthcare plan it is a good idea to know the basics in order to become a more informed consumer. There are a variety of plans to choose from and there is terminology that you should know.

In order to make sure you understand the basics, we have developed a list of most frequently asked questions:

Question: My employer doesn't offer healthcare insurance. Is it mandatory that I carry it?
Answer: Usually it is not a mandatory that you have health insurance but it is a good policy to have if you have no insurance at all. In most states the employer has to carry some form of Workman's Compensation policy but that will only work if you are injured on the job.

Question: I hear a lot of talk about Managed Care. What is meant by this?
Answer: Managed care is the term that is used by some insurance agencies to designate the idea that services are given at a lower cost because members of the plan agree to certain terms. Things like going to doctors who are in a network, having a certain co-pay for doctors visits and prescriptions and going to the doctor when necessary are common rules that apply.

Question: There are so many plans to choose from, how can I be sure I am getting the right one for my needs?
Answer: The best thing to do is to research all the plans that are available in your state. In most states you will choose between HMO, PPO and other types of managed care plans. Some will have you pay a deductible before they pay a portion of your care, others will not. You can do a search on the Internet for more information.

Question: I have heard the terms primary care physician, in network/out of network, deductibles, co-payments and co-insurance in reference to health insurance. What do these terms mean?
Answer: These are all terms that have something to do with how managed care and how it is used. The specific definitions are:

• Primary care physician -- this is the doctor that you will see most of the time for any of your care. If the primary care physician wants you to see a specialist like a dermatologist, they will have to make a referral and have the person accepted by the insurance company. Usually all of the doctors are within the network that your plan provides.
• In network vs. out of network -- this refers to the way that you choose your physicians. "In network" refers to those physicians who are within the network that an HMO has created. These are doctors that are on a list that you will receive when you sign up. "Out of network" are physicians who haven't been approved by your HMO and therefore will either cost you more than in network physicians or that you will have to pay for if you go to them.

Knowing the words and terms of healthcare can often help you get through the maze.

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