FAQs

Health Care 101

What is the best coverage for me?
Because there are so many variables in finding the right health or life plan, you should speak with a Health & Life Consultant to determine which plan best suits your needs.

What is an HMO?
An HMO is a Health Maintenance Organization, and requires you to select a primary care physician (PCP) to coordinate your care.

What is a POS?
A POS, or Point of Service, plan offers in- and out-of-network options with a primary care physician (PCP) feature.

What is a PPO?
A PPO, or Preferred Provider Organization, offers flexibility in physician choice with in- and out-of-network features.

What is a MSA?
A MSA, or Medical Savings Account, is a tax-free, self-funded savings account used to pay for medical expenses. MSAs are attached to high deductible hospital plans designed to cover the insured for catastrophic illness and injury. For more information on MSAs, visit our About Medical Savings Accounts page.

What is a PCP (Primary Care Physician)?
A PCP is a physician that coordinates your care. This usually is a Medical Doctor (MD), Internal Medicine Doctor (IM), General Practice Doctor (GP), or Pediatrician.

What is a provider?
A provider is a physician, hospital, lab or any other health care facility that provides care.

What are plan benefits?
Benefits are services and expenses covered under a health insurance policy.

What are covered or reasonable and customary expenses?
Covered or reasonable and customary expenses are charges that will be considered for payment under a health insurance policy.

What is a deductible?
A deductible is a fixed dollar amount the insured must satisfy before the health plan makes a payment.

What is a copayment?
A copayment is a fixed dollar amount that an insured pays per incident before the health plan makes a payment.

What is coinsurance?
After the deductible is met, the plan begins paying a percentage of covered services, known as the coinsurance. The insured is responsible for the remaining amount until the out-of-pocket maximum is met.

What is an estimated premium?
This is the expected dollar amount that will be paid to the insurance company or health care plan in order to receive health insurance coverage.

What is a drug formulary?
A formulary is a list of preferred medications covered under your prescription drug benefits. Medications outside of the formulary are generally not covered under a health plan or may be offered at a higher cost to the insured.

What is a physician network?
A network is a group of healthcare providers under contract with your health plan. Using your physician network allows you to maximize your benefits and create minimal out-of-pocket expenses.

What does lifetime maximum mean?
This is the maximum a health plan will reimburse to you for covered benefits in the lifetime of the policy.

What is an out-of-pocket maximum?
This is the maximum amount of money the insured will pay for covered benefits in a specified term.

What is the difference between in- and out-of-network providers?
The difference between in- and out-of-network providers is the out-of-pocket expense to you. By using in-network providers you cannot be charged over the contractually arranged fee between your health plan and the provider. With out-of-network providers, you have no protection against fees.