If you don’t know much about healthcare, there may be some terms you are not familiar with. Before you learn the pros and cons of different healthcare plans, you need to learn these terms. The words we will cover are premium, deductible, coinsurance, co-pay, networks, and out of pocket maximum.

Premium

The premium is what you pay every month for health insurance coverage. It is a set amount. Sometimes your employer will pay a portion of your premium.

Deductible

But insurance doesn’t immediately start paying for all your medical costs. Most plans have a deductible, which is the amount you pay before health insurance starts paying for medical expenses. 

Coinsurance

After you reach your deductible, you enter the coinsurance phase. This means you pay a percentage of medical costs, and insurance covers the rest.

Out-of-Pocket Maximum

But you don’t pay coinsurance forever. Each year, there is a maximum amount that you’ll ever pay out-of-pocket. That’s called the out-of-pocket maximum.

Networks

What about Networks? What does it mean to be in-network or out-of-network?

Health insurance companies contract with doctors and facilities to provide lower rates to their members. If a provider or facility is in-network, that simply means your insurance company has contracted with them. 

It is a smart move to contact your insurance company to see if the provider you are going to see is in-network or out-of-network. Often, out-of-network providers and facilities are subject to higher deductibles and max out of pockets than in-network, meaning members will end up paying more money. 

Co-Pay

Lastly, we have the co-pay. This is simply a fixed payment you make to your provider before receiving medical care. Not all plans have co-pays.

How does my plan compare to others? 

Now that you know how to speak healthcare, you can start to learn the benefits of different types of plans and find the plan that best fits you.

Steps Program Basics


Why Participate: So, you and your covered spouse can earn $1 for each day you walk 8,000 or more steps up to 20 days a month. All incentives earned this way are deposited into your HSA.

How to Participate: Create your MotivHealth member account. Sync an eligible device (Garmin, Fitbit, or Apple) and walk your way to $1 a day.

Who’s Eligible: You, the policy holder and a covered spouse.

Rx Program Basics


Why Participate: Spending $200 or more on prescriptions each month? We can help you eliminate or significantly lower your out-of-pocket costs.

How to Participate: Simply call one of our Prescription Benefit Analysts:
(385) 247-1030

Who’s Eligible: You, the policyholder and your covered dependents.

Prompt Pay Program Basics


Why Participate: Save between $250-$3,000 on out-of-pocket costs on planned medical procedures.

How to Participate: Simply call us before your scheduling your procedure, and we'll help you find a participating Prompt Pay facility / provider.

Who's Eligible: You, the policyholder and your covered dependents.

Price Transparency Tool Basics


Why Participate: Lower your out-of-pocket costs by empowering yourself to take charge of your healthcare.

How to Participate: Our Price Transparency Tool is accessed via your member portal. Simply create your account and click "Find Care."

Who's Eligible: You, the policyholder and your covered dependents with member accounts can access this tool.

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