The VanDyke Group | The ABC’s of Your Health Insurance
If all of those health insurance acronyms have you confused read the following article to understand and make a knowledgeable decision regarding your plan options.
health insurance acronyms. health insurance, employee benefits
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12 Sep The ABC’s of Your Health Insurance

It’s that time of year when you probably need to make some decisions about your health insurance. Will you choose a PPO, HMO, or HSA? Are they all QHP? Do you need a FSA or a PCP? What do all of these acronyms mean anyway?

Here’s a list of the most common health insurance acronyms you should be familiar with.

Affordable Care Act is a comprehensive healthcare reform established in March 2010. The goal is to provide affordable healthcare to more people. It is also known as “Obamacare”.

An Explanation of Benefits includes a description of what your health plan covers.

Fee for Service is a reimbursement plan in which doctors and other healthcare providers are paid for each service performed, such as for tests and office visits.

A Flexible Spending Account is an arrangement through your employer that allows you to pay pre-tax dollars for many out of pocket medical expenses, like co-pays and prescriptions.

A High Deductible Health Plan is a type of plan with higher deductibles than a traditional plan. The monthly premium is usually lower, but you pay more health care costs yourself before the insurance company starts to pay its share (your deductible).

The Health Maintenance Organization is a type of health plan that limits coverage to doctors that contract with the HMO. Generally, it does not cover any out of network care except emergency. The primary focus is on prevention and wellness.

A Health Savings Account is a savings account which allows you to put aside pre-tax money for qualified medical expenses. HSA’s are only combined with HDHPs.

Open Enrollment Period occurs annually and allows you to enroll in a health insurance plan.

Out of Network health care services are services with health care providers that are not contracted with your insurance plan.

Out of Pocket expenses for medical care are not covered or reimbursed by insurance, such as deductibles and co-payments.

Primary Care Provider is a physician who directly provides or coordinates health care services for a patient and would be considered your primary doctor.

A Preferred Provider Organization is a type of health plan that contracts with medical providers, such as doctors and hospitals, to create a network of providers. You pay less if you use the providers in the plan’s network and more if you choose out of network.

A Qualified Health Plan is certified by the Health Insurance Marketplace and meets the ACA’s requirement for “minimum essential coverage.”

A Summary of Benefits and Coverage is an easy to read summary that explains the insurance plan and coverages.

A Third Party Administrator is an individual or firm hired by an employer to handle health claim issues and manage the operation of their health plan.


Now with OEP coming up soon you will be ITK (in the know)!



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Material posted on this website is for informational purposes only and does not constitute a legal opinion or medical advice. Contact your medical professional or legal representative for information specific to your needs.