Assured Health FAQ

What is Preferred Provider Organization (PPO)?
A PPO is a group of hospitals and physicians that contract on a fee for service basis with insurance companies to provide comprehensive medical service.

What is a Deductible?
A deductible is the amount of money you or your dependents must pay toward a health claim before the health plan makes any payments for health care services rendered.

What is Coinsurance?
Coinsurance is a provision in your health plan that describes the percentage of a medical bill that you must pay after meeting your plans deductible. The health plan normally pays a higher percentage than the subscriber. (Examples: 90/10; 80/20; 70/30 are the most common types of coinsurance).

What is Out-of-Pocket Maximum?
Also known as Coinsurance maximum or Co-pay limit. The maximum amount (deductible and coinsurance) that an insured will have to pay for covered under expenses under a health plan. Once the out of pocket maximum is reached the plan will cover eligible expenses at 100%.

What is an Explanation of Benefits (EOB)?
An EOB is a description your insurance carrier sends to you explaining the health care benefits that you received and the services for which your health care provider has requested payment. These statements can also show how much of your deductible has been met to date as well as what you have met towards your out of pocket maximum.

What is a Pre-Existing Condition?
A pre-existing condition is a physical or mental condition that existed prior to being covered on a health plan. Some insurance policies and health plans exclude coverage for pre-existing conditions for a certain amount of time. For example, your health plan may not pay for treatment related to a pre-existing condition for six months to a year. Check your evidence of coverage booklet for this information.

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