Health Insurance 101

September 30, 2016, 10:15 am

The Patient Protection and Affordable Care Act (“ACA” ) requires all Americans to carry health insurance by 2014. Here are some helpful definitions to help you understand health insurance and be a more informed consumer.

Copays: The office visit copay is the fee you pay for each visit to the doctor’s office. This is typically the only payment you will make up-front. All other payments owed should be billed to you by the provider after the claim has been sent to Cox HealthPlans and processed. Office visit copays are applied to the coinsurance maximums, not to the plan deductibles.

Deductible: The deductible is the amount an individual pays for their medical services each calendar year before Cox HealthPlans begins sharing the costs for their medical services.

Coinsurance: Coinsurance is the percentage of cost-sharing between you and Cox HealthPlans for your medical expenses. Coinsurance applies after you have met your deductible if you have additional health care needs within the same calendar year. Your health plan will always have a maximum or cap on the amount of total coinsurance you are responsible for each calendar year.

Networks: In-network providers/facilities are providers contracted with Cox HealthPlans. Services provided by in-network providers will be subject to the in-network benefits, which means you will pay less and receive the highest level of benefit under the plan.

Preventative Services: Cox HealthPlans will cover the services outlined in the Patient Protection and Affordable Care Act (PPACA) with no cost share to the member—Cox HealthPlans will pay 100% of the approved charges for these services. A full list of no cost preventive services, along with the preventive service codes can be found by logging into your Member Online Access.