Utah Health Insurance Pool
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Utah Health Insurance Terminology
Buying health insurance in Utah can be confusing, especially because of all the terminology used. Understanding the terminology helps ensure you buy the right policy for your needs and that you understand what you are entitled to.
Network
A network is a group of doctors, health facilities, hospitals and other health care practitioners that accept your insurance and are considered by your insurance company to be acceptable for you to see.
HMO
HMO is short for Health Maintenance Organization. An HMO is a form of health insurance policy you can buy that permits you to see doctors within the insurance company's predetermined network. Visits to doctors or facilities outside that network will not be covered by your insurance.
PPO
PPO stands for Preferred Provider Organization. A PPO is a type of insurance policy that gives full coverage to doctors and facilities visited within the insurance company's network and partial coverage for those that are not.
Pre-Existing Conditions
Pre-existing conditions are health concerns that an insured individual had before taking out her current policy. Pre-existing conditions can be excluded from coverage if the individual has had a break in coverage of more than 60 days.
Co-payment
A co-payment is the amount of money you must pay out of pocket to visit a doctor or hospital, or to pick up a prescription medication. Co-payments usually range from $5 to $100 and are due every time you have an appointment or prescription.
Deductible
Your deductible is the amount of money you must pay out of pocket (excluding co-payments) before your insurance company will begin paying for your expenses. Not every insurance policy has a deductible and they can range from $500 per plan year to $5,000.