How to Understand Health Insurance

Health insurance documentation is complicated to decipher. When you sign up for a policy, you get a thick stack of documents with lots of legal jargon, and you’re left with lots of questions. Here’s how to understand your health insurance better to ensure you get the care you and your family deserve.

Instructions

• 1

  Determine the specific questions you have about your policy and talk with the human resources department at your company or with the customer service department at your health insurance company. Ask specific questions to narrow your search.

• 2

  Look at what type of coverage you have. Catastrophic health insurance covers only horrible illnesses. A PPO covers any treatment you need, so long as services are provided by a doctor or specialist on a provided list. Medicare and Medicaid are public, government-subsidized health insurance programs for which you must qualify before you can be covered.

• 3

  Learn about the terminology you see on your policy. A deductible is the amount of money you must pay out of pocket before your insurance company will start footing the bill. A co-pay is the amount of money you are expected to contribute for something like a prescription or a visit to a doctor’s office. The lower the co-pay, the better the insurance policy is.

• 4

  Check whether your employer is paying for part of your premium. Many companies pay a portion of each employee's health insurance premiums as a benefit of working at the company. Look for where it says Employer Contribution on your health insurance information. This will show you whether your employer is helping to pay for your insurance and how much it contributes.

• 5

  Decide whether the policy is for a PPO (a Preferred Provider Organization) or an HMO (a Health Maintenance Organization). A PPO involves a group of medical practitioners who have determined the standard fee they will charge for different services. An HMO is an organization that has member medical practitioners. The HMO pays all fees for certain types of medical care as long as you use the HMOs medical practitioners.