Definitions Of Terms You May Find As Part Of Your Health Insurance Georgia Policy Article

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Definitions of Terms You May Find As Part of Your Health Insurance Georgia Policy

A co-payment is a fixed dollar amount that the member pays for medical services. The health insurance Georgia provider pays the remaining balance of charges. The co-payment is paid to the health care provider.

Author: Sam Dicosta

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You will have a lot of unfamiliar terms in your paperwork for your health insurance Georgia policy. Here is a quick summary of some of the things you will want to understand.

A deductible is a specified amount that the member must pay every year before the health insurance Georgia Company pays out any benefits. It is sometimes based on a calendar year, meaning from January 1st until December 31st, but sometimes it is based on a twelve-month period starting on the effective date of your health insurance Georgia plan. To explain further, if your health insurance Georgia policy has a $500 deductible, then you must pay all medical bills out of your own pocket until you reach the $500. After that, then you can pay only your co-payment or co-insurance amount.

Co-insurance is a percentage of the charges that the member pays for medical services. The health insurance Georgia carrier pays the remaining balance. For example, you may be responsible for 20% of charges, so 20% is your co-insurance. If your responsibility is a $35 flat fee for physician’s office visits, then $35 is your co-payment. That is the difference between co-payments and co-insurance.

Your out-of-pocket maximum is the most you have to pay each year for medical services. Again, this is usually based on a calendar year. Once you have reached this amount, then you no longer have to pay your co-payment or co-insurance amount, and the health insurance Georgia provider will pay all costs at 100% for covered services.

Your effective date is the day when your health insurance Georgia benefits start. This date is determined by your application process and approval date. Typically, it will be on the first date of the month after you have received approval. Most of the time, you will find this date printed on your health insurance Georgia plan member identification card. You will not receive benefits for medical services received before this effective date.

A pre-existing condition is the term used to a health problem that you have had and have received medical advice, diagnosis, care or treatment for, before the effective date of coverage of your current health insurance Georgia plan. It is possible that pre-existing conditions will result in your being denied coverage, or may affect your premium rate. Also, there are certain times when treatment for a pre-existing condition may be subject to a waiting period, or may be excluded from your health insurance Georgia policy.

If prior authorization is required for certain services, this means that you must call your health insurance Georgia provider to receive an authorization code, or permission, before receiving certain medical services. This is not a guarantee of benefits, however. Often, your health insurance Georgia network physician will get any prior authorization required, but it is ultimately your responsibility to make sure this is obtained before medical services are received.

About Author

Sam Dicosta shares his knowledge on health insurance that makes you able to find the plans that best fits your needs. If you want to know about Family health insurance Georgia, health insurance Georgia, group health insurance, affordable health insurance Georgia, Wellpath north Carolina visit www.cvty-healthinsurance.com

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Definitions of Terms You May Find As Part of Your Health Insurance Georgia Policy