Speaker 1:  Welcome to Health Insurance Made Simple. Part of picking a plan involves understanding some important health insurance terminology. Here we'll discuss benefits, deductibles, co-pays, co-insurance and the out-of-pocket maximum. Let's start with benefits.

Benefits are essentially the health care services your health plan covers. Such as visits to the doctor, routine physicals, visions tests, et cetera. With any health plan there's a premium, which is the amount you pay for your health plan. There are also out-of-pocket expenses. Some out-of-pocket costs associated with health plans are deductibles, co-pays, co-insurance and the out-of-pocket maximum.

Let's start with deductibles. Generally a deductible is a fixed amount of money you pay before your health plans benefits enter into effect. Let's say you have a $300 deductible based on the plan you chose. Once you've paid $300 out of pocket for medical services your health plan benefits will begin to cover costs and you'll only pay portions of your bills with co-pays and co-insurance. A general rule with deductibles is the higher the deductible the lower the premium, and the higher the premium the lower the deductible.

For example, a PPO with a $500 deductible will have a higher monthly premium than a PPO with a $3,000 deductible. Which plan you pick has to do with your own health. Ask yourself, do I visit the doctor a lot? Do I want low premiums? A low deductible? These are the types of questions you might consider when choosing the plan that's right for you.

What about co-pays? These are flat rate payments made each time you use certain health care services such as visiting your doctor, seeing a specialist, or picking up a prescription at the pharmacy. Some plans use co-insurance instead of co-pays or a combination of the two. Instead of a flat rate co-pay, co-insurance is a percentage that you pay for a health care servic

Let's say a doctor's visit costs $100 and your co-insurance amount is 20%. In this case you'd pay the doctor $20 and your health plan would pay the remaining $80.

Finally we have the out-of-pocket maximum. In some cases a member is required to pay no more than a maximum dollar amount in co-insurance and deductibles during a particular period. This amount is known as an out-of-pocket maximum, and once it is reached HAP pays 100% of covered expenses. This may or may not include co-pays.

That concludes health plan terminology, the words you need to know. You can learn more about your health plan options at hap.org. Like us at facebook.com/hap, to see what HAP is doing in the community. You can always reach us by phone. Health Insurance Made Simple, understand your health plan with a little help from HAP.