There are several terms that are used by insurance companies that you should understand before you start shopping for individual health insurance coverage. Here is a list of the terms and how they are applied to your insurance policy:
- MOOP – maximum out of pocket (may also be called OOPL or Out of Pocket Limit)
- This is the maximum amount of money that you will be asked to spend before your insurance covers 100 percent of your medical bills. The amount can vary, and you should choose an amount that is affordable at your current income level.
- Copayment
- This is the amount you will have to spend for a specific event, such as visiting a doctor’s office. The amount is part of the MOOP. It is normally a fixed rate, such as $10 or $20 — not a percentage of the total office visit.
- Deductible
- This is the amount of money you will have to pay before your insurance starts. Each event, such as surgery, has a set deductible (such as $500) which is subtracted from your MOOP. You may also have to pay a percentage after you meet the deductible, depending on the policy.
- HMO – Health Maintenance Organization
- This is a specific group of doctors and hospitals that have joined together to offer services. The focus is on preventative procedures, and there is often a higher deductible, if you use a provider that is out of the service agreement.
- Premium
- This is the amount that you pay directly to the insurance company to have coverage. The premium can vary, depending on your current age, health and coverage limits. The tax credit is applied to this amount, and it may reduce the amount you will pay every month for your individual health insurance coverage.
There may be other terms used that you do not understand. If there is something that is unclear, please feel free to contact a representative with any questions regarding our policies.