Coverage Options

Insurance Center Associates

What is the purpose of coinsurance, stop-loss, maximum out of pocket, etc. Isn’t this just complicating the policy?

All of these are provisions meant to help control the cost of the policy. For example, if the coinsurance percentage tells you how much of the covered expenses the company insurance is on the hook to pay, then clearly the higher the coinsurance percentage, the higher your policy premium will be. Similarly, the lower your deductible and stop-loss, the more you are asking the insurance company to pay, and the higher your policy premium. While these terms my seem complicated, the bottom line is the more of your medical expenses you can afford to pay out of your own funds, the lower your medical insurance premium can be. Your Trusted Choice® agent can discuss the various options available to you, and the amount of difference each will make to your insurance premiums. You can then choose the combination of provisions that best fits your budget and needs.

What if I want to go to any doctor or hospital I choose?

You can buy health insurance which basically says go to whomever you want and have them send us the bill (often referred to as indemnity coverage), but it lacks the negotiated cost discounts and overview of services (meant to dissuade providers from over treating and over billing) that PPOs and HMOs utilize to try and keep costs lower. Thus an indemnity policy may be readily available to you, but may be significantly more expensive than a coverage plan utilizing a PPO or HMO. Ask your Trusted Choice® agent for your options and possible premiums, and then choose the coverage method that best meets your personal preferences and needs.

How does a health insurance deductible work?

A deductible is the amount you must pay before the insurance company begins to pay on your bills. This is an annual amount per insured person, although typically there will be a maximum amount of deductibles you will have to pay in a given year. For example, if your per person deductible is $500, and you have five people in your family covered under your health insurance, the maximum family deductible will usually be $1,500. Once three of the people in your family have paid out a $500 deductible, no more deductibles will apply to any member of the family for the remainder of the year. This can vary, so be sure to discuss the specifics of your policy with your Trusted Choice® agent.

Content from Trusted Choice®