Michigan Health Insurance Glossary

Summarized View:

"Your deductible is set to $500. Your coinsurance can be 15% or you can choose to co-pay $5 per doctor visit". To the layman, this is like solar system lingo – there's no head or tail attached to it. So, here's a glossary of general terms that are normally bandied about in the business of health insurance:

Deductible: A fixed amount representing healthcare bills that you must bear before the insurance policy begins paying.

Coinsurance: The percentage of medical bills you have to bear after you have paid up your deductible. Let's say your coinsurance amount is set to 15%. That means whenever you have to pay healthcare fees covered under your health insurance plan, you have to bear 15% of their value.

Co-payment: This represents a fixed sum you have to pay every time you visit a healthcare center covered by your health insurance plan.

Covered expenses: These are the type of expenses covered by your Medicare supplemental plan. For example, if pregnancy is not covered, you won't be paid for it (assuming you're a woman, J)

Customary fee: This is the average fee that the insurance company feels is reasonable to reimburse. For example, an appendicitis operation may cost you $1,500, but if the insurance company has set its customary appendicitis surgery fee to $800, then you will have to pay the balance from your pocket.

Exclusions: Medical conditions or situations that are outside the purview of your health insurance plan.

Maximum out-of-pocket expenses: This is the maximum fixed amount that you have to pay towards deductibles and coinsurance/co-payments.

Non-cancelable policy: A Medicare policy that cannot be cancelled so long you continue paying the premiums.

Primary Care Doctor: Normally the family doctor or a gynecologist. Your primary care doctor treats minor conditions and will refer you to specialists when required.

Provider: Any medical professional (doctor, nurse, massage therapist, chiropractor, acupuncturist, etc.) or institution (hospital, diagnosis center, etc.) that provides healthcare.

These are the common words thrown about by insurance agents. Hope our small dictionary helps you decipher your heavily worded insurance plans.

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