Selecting the right health insurance plan may be one of the most important decisions Americans will make this open enrollment period, yet many workers do very little research on their health plans.
What is OPEN ENROLLMENT?
It’s the period of time where you are eligible to change your insurance plan, get a new plan, or drop an old plan.
When is OPEN ENROLLMENT? From November 2014 – February 2015 .
The 2014 Aflac Open Enrollment Survey found that 41 percent of employees spent 15 minutes or less researching their benefit options during the 2013 open enrollment season; and nearly a quarter (24 percent) spent five minutes or less.
In contrast, American workers typically spend more time:
Researching for new car purchases — 10 hours.
Planning family vacations — five hours.
Shopping for new computers — four hours.
Deciding what television to buy — two hours.
To be honest with you, before having children and having to deal with major medical bills I didn’t have a clue about insurance. I knew I had it, that I was paying for it, and that I needed it. I didn’t do research prior to open enrollment because I just didn’t know the lingo. It was all so overwhelming, so I ran away rather than facing the problem. Turns out four in 10 (42 percent) workers waste up to $750 each year on mistakes with their insurance benefits! That’s a big chunk of cash that I don’t want to WASTE because I don’t know the ‘lingo’.
As a Mom YOU can become an insurance expert to help your family save money, and maximize your available benefits. Tweet This This is money earned for your family, plus protection for keeping them healthy!!!
Here are a few common health insurance terms that I’ve put into ‘mommy lingo’ to help you understand insurance so that you can maximize your plan for your family.
Copayment (CoPay)— A flat fee usually $20-$40 for a doctors visit. Preventative care check ups are FREE! It’s called Co-pay because your insurance company pays the rest. Example: When my two year old goes for his 2 year check up its FREE with insurance. When he goes because he’s sick and I’m not sure what’s wrong with him, it’s a $30 co-pay.
Deductible—the amount of money you pay each year to cover medical expenses before your insurance policy starts paying for anything. Sometimes you will have a smaller deductible and then they will pay a large percentage of whatever expenses come later. Example: You may have $6,000 deductible. You are responsible for paying every penny of that on your own and then after you pay that $6,000 the insurance company picks up the rest.
Dependent— kids, spouse. Anyone who is covered by the ONE insurance policy but NOT the person who is the primary card holder(generally the husband for SAHM).
Explanation of benefits—the insurance companies way of explaining how a bill was processes. What they paid and then what you will be responsible for. We get these in the mail and it helps walk through each bill instead of just seeing a dollar amount on a bill.
Health maintenance organization (HMO)- These plans are specific to geographical areas. These plans require you to use providers that are in the insurance companies “family”(in-network). Example: You can only use a specific list of doctors. These plans are typically cheaper per month, but become very complicated when choosing a doctor to go to.
In-network provider—A doctor,pharmacy or hospital that is part of the insurance companies’ family (network). You will generally pay less for services received from in-network providers because they have negotiated a discount for their services in exchange for the insurance company sending more patients their way. Example: Our hospital was in network with our insurance company when we had Harrison so we got a bigger discount that other families using other insurance companies)
Network— A group or “family” of doctors, hospitals, and other health care providers that insurance companies contract with to provide services at discounted rates. Example: You will pay less for services in your insurance companies network because they have already negotiated deals with the doctors.
Out-of-network provider—a health care professional, hospital, or pharmacy that is not part of a health plan’s network of preferred providers. Example: You will pay more because your insurance company has NOT made a deal with someone that isn’t in their network or “family”.
Out-of-pocket maximum—this is the MOST money you will pay for the entire insurance year. Your Co-pays, deductibles and co insurance is all included. However you will still be paying the monthly premium costs. Example: If your Out of pocket maximum is $10k and it’s been a hard year and you are swimming in medical bills. Your insurance company will cover the rest 100% after you have met your out of pocket maximum.
Preferred provider organization (PPO)— With these plans you can go to any doctor in or out of network. It’s still a good idea to stick to in network providers for the maximum benefits of your plan. Be sure to ask your dr’s office if they are in your plans NETWORK! Not, do you take said plan. Example: Suzy tells you about a phenomenal new pediatrician that isn’t in your network but you know will help with a skin issue your daughter has been having. You can still go and receive coverage!
Premium—the amount you pay each month. Example: An employer may pay for a portion of your monthly premium and then you pay the rest directly out of a pay check.
Provider—any person (i.e., doctor, nurse, dentist) or institution (i.e., hospital or clinic) that provides medical care.
** this only a sample of insurance lingo to help get you started!
YOU too can be an insurance expert!
- READ your policy over and over.
- Know what you are paying for and what your policy will actually cover. Not all insurance is created equally, and just because you have insurance doesn’t mean you won’t have HIGH medical bills!
- If you have questions, ASK them. Talk to your employer to set up a meeting with your health care insurance agents.
- If you need more information about open enrollment, just visit the Aflac website where you can read the Aflac WorkForces Report.
- Aflac offers accident, dental, life, vision, cancer, hospital intensive care and more voluntary insurance policies.
- Be sure to follow Aflac on Twitter.
Open enrollment is coming, get ready to maximize your insurance for your family!
I was selected for this opportunity as a member of Clever Girls Collective and the content and opinions expressed here are all my own.