Cracking the Code: Health Insurance Jargon Made Easy

Health insurance jargon can be seriously confusing. It’s like they’re speaking a whole other language, right? If you’re trying to get your head around your policy or just starting to look into health insurance, don’t worry—we’ve got you covered. Here’s a simple guide to help you make sense of the most common health insurance terms.

Premium

First up, we’ve got the premium. This is just a fancy word for the amount you pay every month to keep your health insurance active. Think of it like a subscription fee for your favourite streaming service, but for your health.

Deductible/Excess

Next is the deductible. This is the amount you need to pay out of your own pocket for medical services before your insurance starts helping out. For example, if your deductible is £500, you’ll need to pay that much on your own before your insurance kicks in.

Co-payment (or Co-pay)

A co-pay is a fixed amount you pay for certain services, like a visit to your GP or a prescription. So, if your co-pay is £20, that’s what you’ll pay each time you go to the doctor.

Coinsurance

After you’ve paid your deductible, you might still need to pay a percentage of the costs for medical care. This is called coinsurance. If your coinsurance is 20% and you have a £100 medical bill, you pay £20, and your insurance covers the other £80. This Usually only applies to International Policies.

Out-of-Pocket Maximum

This is the most you’ll have to pay for covered services in a year. Once you hit this limit, your insurance takes over and pays 100% of your covered benefits. This includes your deductible, co-pays, and coinsurance.

Network

Your insurance company has a network of healthcare providers and facilities they work with. Staying “in-network” usually means lower costs. Going “out-of-network” can mean higher costs or no coverage at all.

Preauthorization (or Prior Authorization)

Some plans require you to get approval from them before you get certain types of care. This is called preauthorization. It’s their way of making sure the care you’re getting is necessary and cost-effective.

Formulary

This is just a list of medications that your insurance plan covers. Always check if your prescriptions are on this list—it can save you a lot of money.

Claim

A claim is a request for payment that you or your healthcare provider sends to your insurance company after you receive services. If all goes well, the insurance company pays their part, and you get billed for the rest.

Exclusions

These are services or treatments that your insurance plan doesn’t cover. It’s good to know what’s excluded to avoid any surprise costs.

Rider

A rider is an add-on to your policy for extra benefits or coverage. For example, you might add a maternity rider if you’re planning to start a family.

Annual Limit

This is the maximum amount your insurance will pay for your care in a year. If your bills go over this limit, you’ll have to cover the rest.

Lifetime Limit

Some plans have a cap on how much they’ll pay over your lifetime. Many plans don’t have these anymore, but it’s good to be aware of just in case.

Hope this clears things up a bit! Health insurance doesn’t have to be a mystery. If you’ve got more questions or need help finding the right plan, just give us a shout. We’re here to help!