In Sarasota, Florida, health insurance is a concern for everyone. Yet, the FL health insurance industry can seem complicated to someone who is not familiar with how it works. There are terms and policies that can cause the average consumer to scratch their head and wonder what it all means. If you are looking for Sarasota, Florida health insurance, following is a guide of health insurance terms that will help familiarize you with some of the basics of this essential coverage.
COBRA
COBRA stands for Consolidated Omnibus Budget Reconciliation Act. It is short term insurance which became law in 1986. It allows for those who would otherwise lose their insurance benefits to temporarily keep their coverage. Reasons for losing insurance may be job lose, a reduction of hours at work, sickness, or an employer that forgoes offering insurance to employees. The typical coverage period for COBRA is 18 months.
COBRA insurance may still cover dependents as well. Depending on the insurance coverage that you have, your rates may stay the same or they may increase. COBRA is a good option for those in between jobs. Still having coverage while looking for new coverage can give you the time you need to make an educated decision about new coverage and employment.
Co-pay and Coinsurance
A co-pay is a predetermined amount of money the insured must pay for covered medical situations. Co-pays are typically for physician visits, hospital visits, specialist, and lab work. A typical co-payment will range anywhere from $20-$40. Co-pays are different than coinsurance. Coinsurance is the amount the insured must pay to cover medical procedures. It is typically a percentage such as 80/20 or 90/10. Once the insured pays their share of the percentage, the insurance company will pay the rest.
Rider
A rider is an addition to an insurance policy. It describes what medical procedures, benefits, and surgeries will be covered that normally would not be covered under a policy. A rider is optional coverage that is purchased by the insured to cover medical situation that they feel are important. There are many different types of riders available for different medical needs.
Major Medical
Major medical refers to the typical insurance coverage the insured receives from a comprehensive plan. Major medical covers serious medical conditions and expenses down to the basics. Usually a deductible or co-pays must be met and a maximum pay out amount is pre-set. Major medical covers physician visits, hospitalization, lab work, medical tests, x-rays, and other typical medical situations.
Exclusion
An exclusion is a medical service that will not be covered by insurance. Typical exclusions are cosmetic surgery, weight loss surgery, fertility treatments, and certain prescription drugs. A rider can be used to cover some typical exclusions.
Grace Period
A grace period is the amount of time an insurance company will let you keep your coverage after a missed payment. This is something to be very aware of when finding a health insurance plan. A missed payment can result in lapse of coverage after the grace period ends and usually there are fees associated with reinstating your insurance.
Medical Utilization
Medical utilization refers to how much a policyholder uses different medical services such as physicians visits within a year. This data is analyzed to determine if the cost of your premiums will stay the same or increase. If medical utilization is high enough to cost the company more than the monthly premium, the premium will most likely increase. This is a good reason to not overuse your benefits for minor illnesses and questions that could be answered by your doctor’s office over the phone.
Pre-existing Condition
A pre-existing condition refers to a medical condition that was diagnosed by a physician before health insurance coverage began. Most insurance companies will not cover pre-existing conditions making it hard to get new coverage after a diagnosis. Some insurance companies will require a waiting period before coverage begins for a pre-existing condition.
Deductible
A deductible is a predetermined amount of money that the insured must pay before coverage will begin. The higher the deductible, the lower the monthly premium will be. However, it is important to make sure you have enough money set aside to cover your deductible to ensure that you do not lose coverage because of lack of payment.
Application
An application is the paperwork that must be filled out before you can be approved and before health insurance can begin. A typical application will ask questions about age, weight, lifestyle choices, medical history, pre-existing conditions, and family history. Filling out an application properly with all necessary information is very important. Even small details can make a difference in the type of coverage and cost of coverage.
Rate Comparison
Rate comparison refers to the method of finding rates from different insurance companies and comparing the coverage and cost. You can use the rate comparison tool on this page to compare rates from the top companies right now. If you still have questions after this, you can contact one of our independent agents who can answer any questions you may have. You can also call providers individually, but you are likely to get answers from someone well versed in only that company’s offerings. It makes sense to do some comparison shopping for such an important investment.
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Understanding health insurance terms can help you when looking for Sarasota, FL health insurance. By having a grasp on some of the terms listed here, you can find the coverage you need at a price you can afford. Take a second and enter your zip code in the free quote tool above and start getting Sarasota health insurance rate quotes now!