Common Connecticut Health Insurance Terms

We've cut through all of the confusing Connecticut Health Insurance terminology to make it easy for you to understand what you want and what you need. Our Connecticut Health Insurance customers are important to us, which is why we offer  health insurance  information that you truly need.

Annual deductible: The amount of out-of-pocket money a policyholder must pay over the course of a year before the insurance company starts paying.

Co-insurance: The amount of money the policyholder is responsible for paying toward their Connecticut Health Insurance bills.

Co-payment: A flat fee that the policyholder must pay the medical practitioner for medical services or medication. This is common with HMOs and PPOs. The insured pays a small fee, normally no larger than 15 – 20 dollars, and the insurance company pays for the remainder of the bill or medication.

Covered expenses: Expenses that the insurance company pays for including medication, doctor visits, procedures, or supplies.

Flexible spending account: A FSA is an account that allows an employee to set aside pretax dollars toward paying for medical expenses. Both the employee and employer can add to this fund. If there is a remaining balance at the end of the year, the policyholder loses the funds and has to start over with a new FSA. This type of account is beneficial to an employee because it makes it possible to pay for unexpected medical emergencies that are not covered in the health insurance plan.

Group health insurance: An employer purchases Connecticut Group Health Insurance that is available to their employees and employee's families.

Health Maintenance Organization: An HMO is an affordable health insurance plan that includes a wide network of practitioners, hospitals, and other healthcare providers. The organization allows policyholders to access providers connected with the network, but will not pay for any expenses outside of the network.

Health savings Account: Also known as a HSA, is an account designed to help the employee save pretax dollars that go toward paying for medical expenses or used as needed after the age of 65. Left over funds are rolled over onto the next year.

Maximum out-of-pocket costs: The maximum amount of money that a policyholder will have to pay before the insurance company takes over payments. This includes co-payments, deductibles, and co-insurance.

Medicare: Federal funded medical care for individuals 65 years or older and those who have a qualifying disability. There are two parts to Medicare: Part A pays for hospitalization which is paid by Federal taxes, while Part B (also known as Medicare Supplement) pays for other medical expenses in conjunction with the policyholder.

Portability: This is the ability to switch Connecticut Health Insurance Plans regardless of pre-existing health conditions.

Point of service plan: A POS combines elements of an HMO and a PPO. With a POS the policyholder has to choose a primary physician from the network, which is known as the point of service. With this health insurance plan, the individual can see people inside of the preferred network and have all of the paperwork taken care of as well as the majority of the expenses. They can also choose to see someone outside of the network, but this will mean that the insurance company will pay less of the fees and hold the individual responsible for completing any forms required.

Preferred provider organization: A PPO is a type of insurance that pays for a larger percentage of medical expenses if the policyholder sees someone within the preferred network. If the policyholder chooses to see someone outside of the network, then they must pay a larger portion of the medical expenses.

Pre-existing conditions: Medical conditions that are diagnosed before a health insurance plan is purchased. Insurance companies can choose to limit the amount of coverage the policyholder will receive on pre-existing conditions or choose to exclude any treatment from the policy as well.

Supplemental medical insurance: An additional insurance package that can be added on to an existing plan. A supplemental medical insurance plan is purchased for additional coverage not already included in the original plan.