Group News Updates – February 2016


Top 10 Health Insurance Search Terms

“Low health literacy is costing the U.S. health system about $238 billion each year, money that could be used much more effectively to modernize and improve the healthcare system for everyone,” wrote Steven Rush, director of the health literacy innovation program at UnitedHealth Group in a recent blog. Here are the most frequently searched terms employers may want to review with employees this year.

10. Explanation of benefits/EOB

A statement that gives all of the details about what the health insurance plan covers, what the plan does not cover, how much money needs to be paid, and more.

9. Out-of-pocket

Annual out-of-pocket maximum: The most money you have to pay for covered expenses in a plan years.  Out-of-pocket limit: The most you pay during a policy period (usually a year) before your health insurance or plan begins to pay 100% of the allowed amount. This limit never includes your premium, balance-billed charges or healthcare your health insurance plan doesn’t cover. Some health insurance or plans don’t count all of your copayments, deductibles, coinsurance payments, out-of-network payments or other expenses toward this limit.

8. Co-pay/copayment

A fixed amount (for example, $15) you pay for a covered healthcare service, usually when you receive the service. The amount can vary by the type of covered healthcare service.

7. Cost sharing

When you pay some of the costs of your healthcare.

6. HSA

A bank account that lets people put money aside, tax-free, to save and pay for healthcare expenses. The Internal Revenue Service limits who can open and put money into an HSA.

5. Grievance

A complaint that you communicate to your health insurer or plan.

4. Coverage determination

A decision by your health plan about whether a service is covered.

3. Appeal

A request for your health insurer or plan to review a decision or a complaint again.

2. Co-insurance/coinsurance

Your share of the costs of a covered healthcare service, calculated as a percent (for example, 20%) of the allowed amount for the service. You pay coinsurance plus any deductibles you owe. For example, if the health insurance or plan’s allowed amount for an office visit is $100 and you’ve met your deductible, your coinsurance payment of 20% would be $20. The health insurance or plan pays the rest of the allowed amount.

1. Deductible

The amount you owe for healthcare services your health insurance or plan covers before your health insurance or plan begins to pay. For example, if your deductible is $1,000, your plan won’t pay anything until you’ve met your $1,000 deductible for covered healthcare services subject to the deductible. The deductible may not apply to all services.

Reference: Employee Benefit Adviser 1/2016