Glossary Of Group Health Plan Terms

Co-payment – It's the dollar amount of a medical bill that you'll be responsible for. .In many plans you'll decide your co-payment when you purchase your group plan. One example of an instance when you’ll encounter a co-payment is when you go to the doctor. Your visit may cost you $15 for a check-up. The $15 they charge you is your co-payment.

Deductible – The group’s deductible refers to the amount you choose that they will have to pay before insurance coverage starts. Here’s an example: Let’s say you have major medical bill for $8,000 and you have a deductible of $1,000. You’ll have to pay $1,000 first and then your insurance will help cover the remaining $7,000.

Health Maintenance Organization – An HMO is a form of managed care. Its members receive care from only a “network” of healthcare providers. HMOs can be the most affordable for you and your group.

Health Savings Accounts – HSAs aren’t group insurance plans — they’re bank accounts. And those covered under your plan can use an HSA to save money for their future medical costs. They gain interest year to year tax-free, just like any retirement investment fund.

Managed Care – This form of health insurance makes an agreement with a “network” of healthcare providers like doctors and hospitals, to get their medical services for a discount.

Network – A network is the group of doctors, hospitals, clinics, and other healthcare providers that contract with a managed care organization to give discounts for their medical services to plan members.

Preferred Provider Organization – The more flexible form of managed care are PPOs, which give more freedom in choosing a healthcare provider. You can go outside the network with coverage, but will usually be more expensive than in-network care.

Premium – A premium is the monthly payment you’ll be responsible for to keep your group health coverage in effect. And there are plans where you can share the cost of the premium with a group of employees.