In Network/Out of Network
Exclusive provider organization (EPO): A type of plan where claims are only covered if a health care provider is within the plan’s network.
Health maintenance organization (HMO): A type of plan that limits the insurance coverage to health care providers who work for the organization. The plan will typically not cover out-of-network providers.
Preferred provider organization (PPO): A type of plan where health care providers contract with an insurance provider to create a network. Health care providers outside the network can also be used but will cost more than an in-network provider.
Health insurance accounts
Health Savings Account: A medical savings account for individuals enrolled in a High Deductible Health Plan (HDHP). Funds in the account are deducted from an employee’s paycheck before taxes and are eligible for certain medical expenses. Funds roll over from year to year if unused.
Flexible Spending Account: An account set up through an employer to set aside pretax wages to pay for out-of-pocket medical expenses. Funds can be used to cover costs, such as co-pays and qualifying prescription drugs. Unlike a HSA, funds from an FSA do not roll over from year to year.
Health Reimbursement Account: Employer-funded group health plans that can be used to reimburse employees for certain medical expenses up to a certain amount each year. Unlike an HSA, reimbursement accounts do not use employee money to pay expenses.
Deductible: The amount an individual pays before a health insurance provider begins coverage.
Claim: A request for payment sent to an insurance provider from a patient or a health care provider.
Co-pay: A fixed amount an individual pays for a health
care service through insurance, such as a doctor’s appointment.
Out-of-pocket costs: Medical expenses that are not covered through insurance. This can include co-pays and deductibles.
Open enrollment coverage through the Health Insurance Marketplace began Nov. 1.
Source: www.healthcare.gov/Community Impact Newspaper
