How well do you understand health insurance?

Health insurance confuses the majority of consumers

According to industry experts, the majority of consumers don’t understand areas of health insurance.

A survey of 2,500 people conducted by the Association of British Insurers found just under half said their understanding of critical illness cover was a 5 or below (out of 10).

This lack of understanding speaks volumes about the clarity of average insurance policies. Look at our jargon buster to find the meanings of some commonly used health insurance terms.

Health insurance jargon

Coinsurance  – Once you have reached your annual deductable (see below for definition) your insurer will pay a percentage of any healthcare costs after this, usually 70-80%. You will be required to pay the remaining 20-30% as coinsurance.

Copayment (copay) – a flat fee you have to pay for a health service. For example, the copay for a visit to the doctor may be $20, the hospital $50 and so on.

Deductible – this is how much you must pay per year for healthcare related services before your health insurance kicks-in.

Formulary – list of drugs covered by your insurance plan.

PMI – Private medical insurance

POS (Point of Service) plan – these have a network of service providers. You pick your main doctor and receive treatment from pre-approved centres in your network. If you choose to go out of your network for healthcare you may pay more.

Pre-existing condition – a condition that existed before you apply for or enrol in a new health coverage plan.

Premiums – the amount you or your employer pay per month for your health insurance.

Reasonable and customary fee – this is what your insurance provider says is the average payment for a medical procedure or service. It depends on your geographic area, if you pay more than this fee you may not be able to claim all the costs back.

Underwriting – the process by which insurers decide whether an individual is eligible for health insurance and how much they should pay.