Q: What is a premium?
A premium is the amount paid to maintain health insurance coverage, usually monthly. Paying premiums does not eliminate deductibles, copays, or other cost-sharing requirements.
Q: What is a deductible?
A deductible is the amount you generally pay for covered healthcare services before certain insurance benefits begin according to your plan terms.
Example: If your deductible is $2,000, you may pay eligible expenses up to that amount before cost-sharing changes.
Q: What is coinsurance?
Coinsurance is your share of covered healthcare costs after meeting your deductible.
Example: If your plan pays 80% and your coinsurance is 20%, you would pay 20% of eligible covered expenses.
Q: What is the difference between in-network and out-of-network?
In-network providers have agreements with the insurance company that may lower your costs. Out-of-network providers may result in higher expenses or reduced coverage depending on your plan. PPO health plans offer the most freedom to use any in- or out-of-network doctor or facility.
Q: What is pre-authorization?
Health plan pre-authorization (also called prior authorization or precertification) is a process where your doctor must get approval from your health insurance provider before covering a specific medical service, procedure, or prescription. It serves as a check to ensure the proposed treatment is medically necessary, safe, and cost-effective. Many health plans are now available that do not require any pre-authorization. For information on these plans, please call DFW Direct Insurance at 817-449-5557.
Q: What is medical underwriting?
Medical underwriting is the process insurance companies use to evaluate your health history and lifestyle to assess risk. Based on this assessment, the insurer decides whether to approve your application, how much your premiums will cost, and whether to apply any coverage exclusions or limitations. Medically underwritten health plans generally feature lower monthly premiums, since the insurance company can better manage the risk of insuring individuals and families.