Glossary of Terms:

Allowed Amount – The maximum amount a plan will pay for your covered health care services.
Copay – The set dollar amount you pay each time you receive a service or prescription.
Coinsurance – A set percentage you pay toward health care after your deductible has been
met.
Premium – The amount that must be paid for your health insurance or plan. Typically paid
monthly, quarterly, or yearly.
Deductible – The amount you owe for health care services your insurance plan covers before
your plan begins to pay.
Annual Out-of-Pocket Maximum – The most you pay during a policy period before your health
insurance plan pays 100% of your allowed amount. This doesn’t include your premium, balance-
billed charges, or health care that your plan doesn’t cover.
Premium – The amount that must be paid for your health insurance plan.
Marketplace – A health insurance marketplace or health insurance exchange is where
consumers in the U.S. can purchase private health insurance plans and receive income-based
subsidies to make coverage and care more affordable.

Health Insurance Plans

Most health insurance plans offer three different levels of coverage and cost-sharing. Each plan pays a different amount toward medical coverage and prescription drugs. The plan you choose will be determined by how often you visit the doctor, how much you want to pay (deductibles, premiums, coinsurance, etc.), where you go to the doctor and how much you want to pay before your health plan begins.

Many plans are structured into 3 different tiers depending on the type of coverage you need:

To learn more about the different tiers and plans, contact us at Twin City Underwriters.

Frequently Asked Questions

Q: Can I change my health care coverage for the rest of the year outside of my enrollment
period?
A: Yes, you can change your health coverage if you qualify for:

1) A Special Enrollment Period due to a life change – Certain life events, like losing your
health care coverage, moving, having a baby or adopting a child, or a marriage or
divorce, may qualify you to enroll in or change health plans outside the yearly
enrollment period.
2) Medicaid, CHIP, or a new Special Enrollment Period based on income –
Individuals, families, and children with certain incomes may qualify for Medicaid, the
Children’s Health Insurance Program (CHIP), or health insurance through the
Marketplace. Eligibility is based on your estimated household income, and you can apply
at any time.

Q: How are health insurance premiums determined?
A) Some common factors insurance companies use to determine your premiums include your
age, location, tobacco use, who is on your plan (spouse and/or dependents), and the type of
plan you want.

Q: What is an HSA-compatible plan?
A: An HSA-compatible health plan is a health insurance plan that meets the guidelines set by
the IRS regarding deductibles, out-of-pocket expenses, and acceptable coverage. An HSA allows
you to set aside a portion of your earnings pre-taxed to pay for qualified medical expenses.

Q: What is a catastrophic coverage plan?
A: A “catastrophic plan” is a qualified health plan offered through the Marketplace that covers
essential health benefits and requires the highest level of cost-sharing allowable for essential
benefits.

Q) How do I know if my doctors are in the network?
A) Call your insurance company, check online, or reach out to your agent. You provide both the
specific plan name you are referencing and the doctor’s name to confirm whether or not the
provider is in the network.