At HealthPlus, we know that looking for health insurance
can be confusing so we’ve outlined some some important health insurance terms
to help get you started.
Health Insurance Terms
PolicyA policy is a contract between an individual and an
insurance provider. A policy can also
exist between a provider and an individual’s sponsor, employer or community
DeductibleYour deductible is a fixed dollar amount during the
benefit period - usually a year - that you pay before HealthPlus starts to make
payments for covered medical services. Plans may have both per individual and
family deductibles. Some plans may have
separate deductibles for specific services and deductibles may differ if
services are received from a provider in or out of network.
Preferred Provider Organization (PPO) PlanA plan where coverage is provided to participants through
a network of selected health care providers (such as hospitals and physicians). Enrollees may go outside the network but would incur higher costs from these
Health Maintenance Organization (HMO)A health
care system that assumes both the financial risks and responsibilities associated
with providing comprehensive medical services (insurance and service risk) in a
particular geographic area, usually in return for a fixed, prepaid fee.
Financial risk may be shared with the providers participating in the HMO.
Primary Care Physician (PCP) A physician who serves as a primary contact within a
health plan. In a managed care plan, the primary care physician provides basic
medical services, coordinates and often authorizes referrals to specialists and
Benefits An explanation of benefits is a document that may be
provided by an insurer to a patient outlining what is covered for a medical
service and how payment amount and patient responsibility amount are determined.
At HealthPlus, we’re here to help! If you have any questions, please contact us.
HealthPlus provides services all over Michigan. Find out if you’re in our service area.
HealthPlus has thousands of providers, hospitals and pharmacies. Find one that’s right for you.
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