Key Terms and Other Benefits: Understanding Health Insurance

[Music] let's move on from plans and talk about some key players and important terms for instance I'm sure you've heard the term provider' before a provider is a person or a place that provides health care services such as a clinic hospital doctor laboratory healthcare practitioner or pharmacy an insurance carrier or simply carrier is the insurance company providing coverage you're probably familiar with some already like United Healthcare Blue Cross Cigna and Aetna a subscriber as the policyholder on the account and independent is any person covered by the

policy other than the subscriber a dependent can be a child or a spouse a guarantor is the person who is ultimately responsible for the bill anyone 18 and over and not incapacitated as always their own guarantor if the person is under 18 their guardian is their guarantor you probably see in the next few terms while reviewing your benefits like the term essential health benefits which are a set of health care service categories that the Affordable Care Act ACA has required certain plans to cover since 2014 a pre-existing

condition is any health condition or disability either physical or mental that occurred before new insurance coverage went into effect beginning in 2014 insurers can no longer deny coverage to or charge more for people with pre-existing conditions unless they are covered by a grandfathered individual health plan so what's a grandfathered plan this is a health insurance plan that was in effect before the Affordable Care Act became law grandfather plans are exempt from some of the ACA Zrii forms a summary of benefits and coverage or SBC is an

easy-to-read outline that lets you make apples-to-apples comparisons of costs and coverage between health plans you'll get an SBC when you sign up for renew or change coverage you may also request one from your insurance company whenever you'd like here are a few other types of insurance benefits not to be confused with your health care benefits prescription insurance helps pay for prescription drugs and medications and is sometimes offered as part of a larger health insurance plan stand-alone individual prescription insurance may be available for those who are not offered

coverage to their health plan dental insurance is used for dental care and typically includes things like regular checkups cleanings and x-rays some plans may also provide coverage for certain types of oral surgery dental implants or orthodontics and then there is vision insurance which covers routine eye exams and other procedures and provide specified dollar amounts or discounts for the purchase of eyeglasses and contact lenses some vision insurance policies also offer discounts on refractive surgery okay still with me

it's a lot to take in but so important to understand the fundamentals first but next we're going to dive into something that's always top of mind