Understanding Insurance: What's in Your Network

Health insurance can be confusing for everyone. However, those who aren’t used to the terminology or who haven’t had to select insurance before may end up making the wrong decisions for their health care needs. In 2016, GreyHealth Group conducted a study that said that millennials were more likely to consult online experts and informal sources than conform to the “old” model of consulting a primary care physician. Because millennials don’t solely rely on a physician, they may not know or understand these basic health insurance terms. Here are a few that everyone should know:

Premium: Your premium is the amount of money you pay each month for health insurance. With company-provided health insurance, the employer contributes a percentage of the premium and employees pay the remaining amount. When looking at health insurance plans, look at the cost of premium and deductible.

Co-pay: Your co-pay will be outlined in your healthcare plan. This is a fee you would pay the provider for receiving medical services. This amount will vary depending on what type of physician you are visiting. For example, if you are seeing a primary care doctor, who is considered in-network, you could pay a $20 co-pay at the time of service, depending on your plan, but you may have a $60 co-pay for a specialist.

Deductible: The fixed dollar amount you pay each year before your health insurance company will pay a claim. Co-payments generally count towards your deductible, but you should call your insurance company to clarify. According to Healthcare.gov, plans with lower monthly premiums have higher deductibles, and plans with higher monthly premiums have lower deductibles.

Network: This is your health insurance plan’s network of facilities, providers and suppliers your health insurer or plan has contracted with to provide medical services. In-network providers will be covered by your insurance. Out-of-network providers or facilities may cost more.

Out-of-pocket: Your out-of-pocket costs are your expenses for medical care that are not reimbursed by your healthcare plan. Typically, a plan will have a maximum out-of-pocket amount. Once that amount has been met, your insurance company covers all subsequent costs.

Benefits: The medical services, treatments and supplies covered by your healthcare plan. The dollar amount or percentage, if any, the carrier pays for benefits varies by plan.

For more information about benefits, speak with your employer’s team resources or call your insurance company.