What is health insurance?   

• It pay for healthcare treatment costs.
• It pays for doctor visit, X-Ray lab and test, out-patient treatment, surgery, ambulance, maternity, prescription, etc. Coverage varies from plan to plan.
• It pays for unexpected medical emergencies.
• It can cover pre-existing conditions under certain terms and conditions. Such as, if you completely disclose about your pre-existing condition in application during submission and underwriter approves it then yes, that pre-existing condition will be covered. Remember, all pre-existing conditions are not covered.

• Preferred Provider Network (PPO) - A managed care organization of medical doctors, hospitals, and other health care providers who have covenanted with an insurer or a third-party administrator to provide health care at reduced rates to the insurer's or administrator's clients. PPO sometimes referred to as a participating provider organization or preferred provider option. PPO allows members to choose any provider but offers higher levels of coverage if members receive services from health care providers in the plan’s PPO network. These in-network providers have contracted with the health plan to provide services at negotiated reimbursement rates.
• Health Maintenance Organization (HMO) - An organization that provides or arranges managed care for health insurance, self-funded health care benefit plans, individuals and other entities in the United States as a liaison with health care providers (hospitals, doctors, etc.) on a prepaid basis. A type of health benefits plan for which members are required to receive health care only from providers that are part of the HMO network. A primary care physician coordinates each member’s health care. Services (except emergency care) performed by out-of-network providers aren’t covered except under specific circumstances.
• Health Saving Account (HSA) - HSA is a tax-advantaged medical savings account available to taxpayers in the United States who are enrolled in a high-deductible health plan. The funds contributed to an account are not subject to federal income tax at the time of deposit. HSA account that reimburses employees for specific health care expenses. HSAs can be funded by the plan member, an employer or anyone else. The money contributed to your HSA belongs to you and can be used to cover eligible current or future medical expenses. If the HSA meets rules under the Internal Revenue Code, contributions, earnings and withdrawals for eligible expenses are not subject to federal income taxes or employment taxes.
• Health Reimbursement Arrangement (HRA): HRA account that reimburses employees for specific health care expenses as expenses are incurred. HRAs are funded by employers.
• Flexible Spending Account (FSA): FSA account that reimburses employees for specified expenses (for example, health care or dependent care) as expenses are incurred. FSAs are usually funded through deductions from employees’ paychecks. If the FSA meets rules under the Internal Revenue Code, contributions are not subject to federal income taxes or employment taxes.

• Deductible: Amount you have to pay each calendar year (annually) for covered services before your health care plan starts paying. For some services, the plan will even begin to pay before the deductible is met.
• Co-insurance: Percentage of the cost of covered expense that you will be responsible for, after your annual deductible is met.
• Co-payment (also known as Copay): Specified dollar amount you have to pay for certain covered services.
• Out-Of-Pocket Maximum: Most that you would pay in a calendar year for deductible and coinsurance for network covered services. Once you reach this maximum, the plan pays at 100% for most services for the rest of the calendar year.
• Premium: Amount you pay to buy health insurance plan.
• Exclusions: Medical services that are not covered in plan.
• In Network: Doctor, hospitals and other participating providers has agreed to accept lower costs for their covered services.
• Out-Of-Network: Healthcare services received outside the network of providers of insurance company.
• Pre-existing condition: Health condition that exists within you, prior to insurance plan effective date.
• Formulary: List of prescription drugs that health insurance plan covers.

• Generic Drug: Prescription drugs that typically have been in use for some time and can be manufactured and distributed by numerous companies, so their cost is usually much lower. Generic drugs must, by law, contain the same active ingredients as their brand name equivalent and have the same clinical benefit.
• Brand Drugs: Prescription drugs that are manufactured and marketed under a registered name. They are usually patented and may be exclusively offered by certain manufactures.
• Specialty Drugs: These are typically high cost, scientifically engineered drugs used to treat complex, chronic conditions. They require special handling and usually must be shipped directly to the user.
• Formulary: List of prescription drugs that most of health care plan covers. They include generic, brand name, and specialty drugs that have been rigorously reviewed and selected by a committee of practicing doctors and clinical pharmacists for their quality and effectiveness.