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I have 6 years total experience & 4 years managerial experience in the field of Insurance, banking & finance, which includes Sales, Recruitment, Team handling,
Now I want to start a ... |
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Additional Details
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Dr Kate | Health insurance question: what does some of this stuff mean? Coinsurance, 4th quarter carryover, etc? |
My health insurance just changed. We got a form that shows the differences between the two companies. I have a few questions about stuff that I don't understand. (I am a veterinarian, not a human doctor, so please don't ask me why I don't know this if I am a doctor.)
1. It says that for the deductible per calendar year, there is "no 4th quarter carryover". What does that mean?
2. What is "coinsurance"? What does "coinsurance-out of pocket" mean? They gave me a monetary value for that.
Thanks!
Additional Details
Also, are office calls included in the deductible? Meaning, I have a $20 office call copay, but a $500 deductible. Does that mean that I pay for all my office calls until I hit $500, then they cost me $20? |
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Brad Tolar
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In some group plans the money you contribute towards the annual deductible in the last 3 months of the current year will be applied to the deductible in the next year.
1. Your new policy does not offer that benefit. Deductible payments are only applied in the current year.
Coinsurance is the amount you pay out of pocket for example a plan that was 80/20 you would have a 20% Coinsurance. That means for each $1000 in medical expenses; you will spend $200 out of pocket.
Out of Pocket Maximum is the maximum about your coinsurance can add up to. Once you have reached that out of pocket maximum your plan will pay 100% of remaining up to the plan maximum. You can read all about group health insurance at http://www.lvhealthins.com under group insurance.
By the way some of the responses you have gotten have confused coinsurance with copayment. Copayment is a form of deductible for the doctor's office. It is not coinsurance. |
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Zarnev
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1. This means that any money you pay toward the deductible in the 4th quarter of the year does not carry over toward the deductible for next year. Some companies do have this carry over.
2. After you pay the deductible, you are responsible for a certain percentage of the charges until you've paid the out-of-pocket maximum amount, which is the monetary value they gave. Then the insurance will pay 100% of the allowable charges. For example, you have a $1000 deductible and co-insurance of 80/20 to $2000. If you have a $4000 hospital bill you pay the first $1000 and 20% of the next $3000 for a total of $1600 and the insurance company pays $2400. |
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Lori S
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Zarnev is correct. Just to add to his answer, as far as the co-pay part of your question. It depends on how the policy is written. Some preventative or "well-check" benefits (such as pap smears) will only cost you the co-pay amount. These circumstances will be listed in your policy. Most others you will pay for and will apply to your deductible. These amounts are a discounted rate that your insurance has with contracted providers. |
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mbrcatz
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1. That means, when January 1st rolls around, everything resets, regardless of when the policy was taken out.
2. That means, the percentage of every claim you pay.
Yes, if you have a $500 deductible with a $20 copay, you pay the entire first $500, and then you pay $20 for every visit after that, until January 1st - when the $500 has to be repaid again. |
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BRENDA T
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You could try to google it ,here is some direct resource might be helpful.http://health-insurance.expert-tip.info/affordable-dental-health-insurance.html |
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s and d e
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#1---say you have a $500 deductible and by the end of the yr, you've only used $300 of it. that $200 not used does not carry over to the next policy year. it simply means that each separate year, you have to meet the deductable.
#2--co-insurance is simply any other coverage you may have. like if you're married and your husband has you on his insurance at work. the policy you carry becomes your primary insurance. whatever you pay out of pocket that is not covered under the secondary insurance, you are not ellibigle to be reimb. for.
i hope that makes some sense--it would take a lot of room to really explain. feel free to e-mail me if you would like to. |
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