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A PPO, POS, HMO, and PCP may help you in the hospital. An IOU and TLC may be waiting for you when you come home.


Insurance Lingo

PCP:
Your primary care physician or family doctor. If you've moved to a new city, forward your health records and get a physical with a new PCP. You'll end up thanking yourself when you're a flu-ridden, sniveling mess in need of medicine.

"In-network" doctors:
A list of doctors approved by your plan. Those not in your list are considered "out-of-network."

Premium:
Your monthly payment for insurance coverage. Your employer may pay some of your premium.

Payable in Pop-Tarts:
If you see this term in an insurance document, something's wrong.

Deductible:
The dollar amount (usually per calendar year) you need to pay for medical expenses before the insurance kicks in.

High-deductible plan:
You get lower premiums (yeah!), but insurance won't help you until your medical expenses really start to add up (boo!).

Out-of-pocket:
The money you (not your insurance company) pay.

Out-of-pocket maximum:
The most money you'll have to pay in a calendar year for "reasonable" and "customary" care. This amount becomes important after your deductible is met and you're sharing a percentage of the costs with your insurer.

Pre-existing condition:
The requirement to disclose your allergy to whale blubber (helpful for that emergency surgery when on vacation in Juneau).

Lifetime maximum benefit:
The maximum amount that your insurance company will pay during your lifetime. For cats, multiply this number by nine.

Co-payment:
A small fee (often $5 to $20) that you pay every time you visit a doctor. It's like a movie ticket with less movie and more disrobing.


Health Insurance Plans

Below is a general overview of different plans. Unfortunately, the number of variations on them is painfully infinite. As you scroll down the page, each new plan provides a greater degree of flexibility, but it comes at a higher price.

Decisions you make about insurance coverage are important because you're usually only allowed to change your plan once a year. You can't get sick and then say, "Ooo! I want the good plan now." They've figured that one out already.

Standard HMO (Health Maintenance Organization)

- Least expensive, least flexible
- Must visit family doctor (PCP) prior to network specialist
- Insurance only pays for doctors "in network"

Standard POS (Point of Service)

- Moderate price and flexibility
- Must visit PCP for "in network" doctors
- You can go "out of network," but more expensive

Standard PPO (Preferred Provider Organization)

- Most expensive, most flexible
- No PCP visit necessary
- You can see most doctors, but "out of network" is still more expensive

You've been presented with a number of choices. Which one is best for you? To start, your employer may offer you a certain plan (usually of the HMO variety) as a benefit of your employment. You may have the option to upgrade your plan.

If you are prone to sickness or concerned that you may need a specific specialist in the event of an emergency, you may want to consider a more comprehensive plan, like a PPO.

Health insurance companies negotiate a lot of deals. So by having a health insurance policy (even a high deductible plan), you'll get the benefit of "insurance discounts" on doctor visits, tests, and prescription medications, even if you're paying out-of-pocket.


Story Time

When Bert was young, he had eleven fingers. While this made him a whiz at video games, it didn't help him earn the affection of a redhead in his social studies class.

Unfortunately for Bert, his local drugstore didn't carry finger removal cream, so he needed to see a specialist.

He originally wanted to see Dr. Fingerbegone due to his fortuitous name, but this specialist was not considered "in-network" for Bert's HMO.

In order for his insurance company to pick up some of the cost, Bert needed to use Dr. Chopitov, who had also worked with a handful of patients.

Bert could still go to Dr. Fingerbegone, but he'd have to pay the entire bill himself.

Bert chose to pass on the surgery, but he managed to get a date with the redhead. He just had to wait for a cold day in January ... when he was wearing mittens.