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Here we list definitions for some terminology you may come across in the context of healthcare plans.
Deductibles are usually for one year, meaning that meeting a deductible for one year only lasts for that policy year--the deductible will be reset for the next policy year. Deductibles vary from policy to policy. Some have no deductible, some have a deductible applied to all medical services, just to some medical services, to all family members, or a per-individual deductible.
Some insurance plans allow you to choose a higher deductible with the benefit that you have a lower premium.
Each insurance plan will define more precisely what kinds of dependents can be covered.
HMO | PPO | |
---|---|---|
Enrollment | Enroll for specific period of time. Costs and coverage may change at each new enrollment period. | |
Premium, Copayments & Deductibles | Fixed, pre-paid premium. A small additional copayment may be required for some services. | In addition to a premium, copayments and deductibles must be met for services rendered. |
In-Network Benefits | Required to use participating (or approved) providers for all services. | Receive services at discounted rates. |
Out-of-Network Benefits | None except in life or death emergency circumstances. | May go to any out-of-network doctors or facilities, but pay more than for in-network services. |
Authorization | Pre-approval by the HMO is likely to be required to receive most services, including specialty care, hospitalizations and many procedures. | Pre-approval required for hospitalizations. |