Medical Insurance & Benefit Terms Explained

The U.S offers some of the best healthcare in the world, however it is a FOR PROFIT healthcare system. It can be extremely expensive if you do not have sufficient healthcare insurance. Medical providers in the U.S. work on a "fee for service" basis, which means physicians expect to be paid when they treat you for a medical condition.

Dental/Vision Care: A few companies offer supplemental insurance policies that include dental/vision coverage. Without this coverage any issues become an out-of-pocket expense. Dental care, especially, can be an extremely expensive out-of-pocket cost.

Traveler's Insurance:Is a lower cost option for compliant coverage but it comes with limitations. Buyer beware; these companies routinely deny payment of claims. Appeals take time and sometimes are still denied.
Traveler's insurance usually provides coverage for new onset medical issues and emergencies. The following are usually NOT covered: dental care, vision care, school physical exams (required to enroll your children into the public school system), routine physicals (i.e. well baby checks, women wellness exams), immunizations, pre-existing conditions (i.e. asthma, allergies, blood pressure, diabetes, heart conditions, bone/joint conditions, etc.), elective procedures, dermatology.

80/20 Policies: Many traveler's insurance policies have coverage restrictions. If it lists 80/20 until $5,000.00, this means that the insurance will only pay 80% of the COVERED expenses until the bills reach $5,000.00. After reaching that amount, the company will pay 100% of COVERED expenses.

Deductibles are the portion of each members' medical bills that you agree to pay before the insurance company begins making payments. We recommend a $0.00 deductible but no more than $100.00 per person.

Co-Payments are your share of the cost that is part of the contracted rate between your insurance company and providers in your insurance company's network. For urgent care visits, expect to pay $20.00 to $30.00. The co-payment for Emergency Room visits to the local hospital are typically $100.00 to $250.00. It varies by company.

In-network providers are listed on your insurance company's website. These doctors, specialists, laboratories, hospitals and pharmacies have a payment contract with your insurance company. In short, they agree to accept the company's contracted rate as payment in full. You will be responsible for any co-pay.

Out-of-network providers are likely to cost you more out-of-pocket for medical care. Providers outside your network have not agreed to any set rate with your insurer, and may charge more. Your co-pays and co-insurance payments are also typically higher for out-of-network care.

Claims/Proof of Loss Forms are sent to insured families. Payment will not be made on you/your family member's behalf unless you fill out the forms and sent them to the insurance company in a timely manner.

Sports Coverage is an option for purchase with many insurance companies. If your child plans on playing on a school sports team, this additional purchase is required.