Terms

• Premium

  • The amount that must be paid for health insurance.

• Co-pay

  • A fixed amount paid for a covered health care service.

• Deductible

  • The amount paid out of pocket for covered health care services before health insurance begins to pay.

• Co-insurance

  • The consumer's share of the costs of health care service, calculated as a percent of the amount for the service.

  • Generally, the consumer will start to pay co-insurance after they have paid the health plan's deductible.

  • Most common co-insurance plans you may see is an 80/20 plan. After the deductible is paid. The insurance company would cover 80% of the health service cost and you would be responsible for the remaining 20%.

• Open enrollment

  • Is the period of time during which individuals can enroll in a qualified health plan.

• Special enrollment period

  • A time outside the yearly open enrollment period when consumers can enroll in health insurance. They may qualify for a special enrollment period if they have had a qualifying life event.

  • Examples of life events... Loss of Health Coverage, Birth, Adoption, Foster Care, Child Support or Court Order, Marriage, Divorce, Legal Separation, Death, Move, Gain Lawful Presence or Citizenship, Enrollment Error, American Indian or Alaska Native, and Special Circumstances.