Frequently Used Insurance Terms
- COBRA (Consolidated Omnibus Budget Reconciliation Act)
COBRA is a Federal provision which allows an employee or dependent stay insured temporarily through a terminated plan. Please be aware, these plans are usually very costly on a month by month basis. You have 31 days to enroll in a new plan after your current plan has been terminated.
A dollar amount or percentage you are responsible for paying for your covered health-care services. You may have to pay a set amount every time you make an office visit, a different amount for lab work, and various amounts for different types of prescription drugs. You may have to meet a deductible before your co-pay or co-insurance kicks in.
The amount you have to pay for covered medical services before your health plan starts paying. Your deductible amount may be very small or really large. What size it is depends on you; you can trade off the costs of a high deductible with a lower premium.
A health condition or circumstances not eligible for coverage under your health plan. What your plan doesn’t cover is listed in the Certificate of Coverage for your benefits. Call your plan’s customer service number to get a copy of your Certificate of Coverage. If you have a chronic or unusual condition, check the exclusions carefully before choosing a plan.
- Maximum - Annual or Lifetime
An upper limit on costs or services covered by a plan. For example, a plan may limit you to 60 days of occupational therapy or put a ceiling on the dollar amount of coverage it will provide over your lifetime. Some plans have limits; some don’t, so check your policy.
- Open Enrollment
Usually scheduled during the three months before the effective date of a benefit plan. This time is a window of opportunity during which you can make changes to your benefits package without having to prove creditable coverage or a qualifying event.
Money you pay toward the cost of healthcare services. It’s essentially money you have to dig out of your own pocket, so it's aptly named. Out-of-pocket expenses include deductibles and co-payments. Sometimes, what you pay for services not covered by your plan is considered out-of-pocket as well. Plans vary widely in the amount of out-of-pocket costs you pay. Some plans put a cap on your out-of-pocket expenses. After you reach the out-of-pocket limit, the health plan pays all you are covered.
The cost of an insurance plan. An employer may pay part of your premium if you get you health benefits through your company. Pay attention to what your premiums cost- your employer’s contribution is part of your compensation package. You can find this amount on your paycheck stub.
- Primary Care Physician (PCP)
A doctor who serves as your main contact with the health-care world, providing basic care and referring you to specialists as the need arises. The BGSU Student Health Service serves as your PCP if you are in enrolled BGSU-offered insurance plan.
- Qualifying Event
Certain events that would ordinarily cause an individual to lose health coverage. Sometimes know as life changes. These events include aging off a parent’s insurance plan at 23-25 years of age, getting married, getting divorced, having/adopting a child, or the death of a spouse or parent.
A payment either to you or a health care professional for covered medical services. A fee-for-service plan may reimburse you or your doctor a set amount or maximum amount for specific services. This system can lead to larger out-of-pocket costs for you. For example, your doctor may charge $60 to remove that pesky wart, but your health plan pays just $40. You may have to pay the difference. On the other hand, your health plan may negotiate the doctor’s fees in advance, including an agreement that prevents you doctor from billing you for the remaining $20.
A specialist is an expert in a specific area of medicine. You may need an Oncologist to treat cancer; a Nephrologist to treat kidney disease; or a Pulmonist to treat a serious lung conditions.