1. What is a deductible?

It is a specific dollar amount that an individual must pay (or “satisfy”) before reimbursement for expenses begins. The higher the deductible, the lower the cost of the health insurance plan.

2. What is co-insurance?

The co-insurance clause requires you to pay a percentage (or a fixed amount) of your covered medical expenses. The percentage is usually expressed as “80/20″ co-insurance. This means after you have paid the deductible amount (if any) as stated in your policy, you will pay 20% of the medical bills and the insurance company will pay the remaining 80% of the covered medical expenses. When your total expenses reach a dollar amount stated in your policy, the insurance company pays 100% of the covered expenses up to the maximum benefit of your policy.

3. What is a HMO?

A health maintenance organization (HMO) is an organization that provides comprehensive health care to a voluntarily enrolled population at a predetermined price. Members pay a fixed fee, directly to the HMO and in return receive health care services as often as needed.

4. When does my coverage begin?

All health plans are subject to underwriting approval. Do not cancel any current policies until issued an effective date.

5. What is a waiver?

A term used when a particular area of the insured is not covered due to previous history. Some are temporary and some are permanent.

6. What is an exclusion?

This states the types of injuries or illnesses that are not covered. All policies have exclusions. the most common types of exclusions are pre-existing conditions, self-inflicted injuries and injuries incurred while committing a criminal act. Injuries resulting from some specific activities may also by excluded.

 

For any other questions regarding health insurance contact Illinois Health at 1-800-707-5795 and speak with a local Illinois insurance agent today!