Accident Only Insurance is a type of limited benefit policy that provides coverage for death, dismemberment, disability or medical and hospital care specifically caused by an accident. With an accident only insurance policy, death, dismemberment, disability or medical and hospital care would be covered providing the cause was unintentional and solely accident-related. In addition, an accident only policy can include the purchase of accident coverage for certain accidents only. For example, a policy just for unintentional-injury death or specifically for extended hospital care due to a personal injury may be purchased.
Information Source: National Association of Insurance Commissioners (www.naic.org)

Association Group Health Insurance is a type of health insurance plan offered by an association, including professional groups or affinity groups. American Association of Retired Persons (AARP) is an example of an association group. This type of plan provides health insurance coverage that is intended for the maximum benefit of the group’s members. As long as a policyholder remains a member of the group, they will have access to the group’s health insurance benefit. The plan is provided by a state-regulated licensed insurer who insures the plan sold to members of the association. Group plans may be guaranteed issue or underwritten according to state laws in which the plan is held. Mandates on group coverage are also in accordance with state laws, which affect the rates of the plan depending on the level and amount of state required mandates.
Information Source: Council for Affordable Health Insurance (www.cahi.org)

Beneficiary: is the person, party, or legal entity designated by the owner of an insurance policy to receive the policy benefits as detailed by the particular policy. This is typical of life insurance policies, but can also be included in a health insurance policy when a supplemental life insurance policy is included, such as the case of an Accidental Only policy. In such cases, the beneficiary would receive the benefits specified in the individual’s policy. The policy owner names the beneficiary in the policy and, as is the case of an irrevocable beneficiary, beneficiary designation can only be changed with the current beneficiary’s consent.
Information Source: National Association of Insurance Commissioners (www.naic.org)

Brand Name Drug: is a prescription drug that is marketed and patented with a specific brand name. The company that manufactures the drug is also the company that develops, conducts testing, patents, and submits the drug to the Food and Drug Administration (FDA) for approval. While the drug is under patent law protection, generic versions are not available and the only option for a patient is the brand name drug. A pharmaceutical patent usually lasts for twenty years from the date the patent application was filed. When the patent runs out, generic versions will be marketed and sold by other companies at a lower cost, with the savings benefiting the patient. Most health insurance or prescription drug insurance plans will pay for generic versions, if available, before brand name drug versions. It is important to check the insurance plan to determine policy provisions on brand name drugs and generics.
Information Source: Health Insurance Resource Center (www.healthinsurance.org)

Cancer Insurance is a type of limited benefit policy plan designed to provide coverage for the diagnosis and treatment of cancer. This plan covers all of the related costs associated with the policyholder’s cancer treatment. This specified disease coverage plan is designed to relieve the financial burden associated with medical costs. Depending on the particular insurance plan, regulations of use, including deductibles or policy maximums, may apply.
Information Source: National Association of Insurance Commissioners (www.naic.org)

Cash Indemnity Insurance is a type of major medical insurance plan that covers serious illness or injury costs and requires a deductible when costs are otherwise too high. Typically, cash indemnity insurance has a pre-determined deductible that the policyholder pays before the insurance company will begin paying benefits. Once the covered expenses reach the amount above the deductible, the remaining amount is paid as a percentage of the expenses’ actual cost. Most insurance plans implement that percentage at 80%. The cash indemnity insurance plan is particularly accommodating in determining where the policyholder would like to receive their medical care.
Information Source: National Association of Insurance Commissioners (www.naic.org)

Catastrophic Insurance, also known as high deductible health insurance, is a type of insurance that provides coverage for more catastrophic medical illnesses serious enough to require expensive medical treatment. The plan is characterized by high deductibles and lower monthly premiums. The policyholder will incur out of pocket expenses such as physician visits, regular and annual preventive screenings, and prescription drug costs. In the event of a major medical or hospital-related stay, the policyholder would pay a pre-determined deductible and the rest of the expenses would be covered by the plan. This includes any type of surgery, emergency room or hospital stay, and hospital performed tests or X-rays. Catastrophic insurance is attractive because the policyholder does not pay for coverage that is not used and will still be covered in the event of a major medical illness. Information Source: Council for Affordable Health Insurance (www.cahi.org)

Consolidated Omnibus Budget Reconciliation Act (COBRA) is a continuation coverage insurance plan provided to employees and their families in the event that health benefits are lost, whether it be from involuntary or voluntary job loss, reduction in hours worked, death, divorce, or other life events. This type of coverage enables the employee to receive continued health benefits under their original plan for a limited period of time. Under COBRA, which was passed by the U.S. Congress in 1986, employees receive notice of their opportunity for election of continued coverage and the premium amount. The former or non-qualified employee will receive medical care including inpatient and outpatient hospital care, regular physician visits, prescription drugs, surgery and other major medical benefits. The premium for continued coverage may be the full cost of the coverage, plus a percent administrative charge. The continuation coverage premium will be more expensive than the coverage of an active employee because the employer is still paying a portion of the former or non-qualified employee’s coverage, regardless of the fact that he or she may no longer be an active employee. COBRA continuation coverage is often less expensive than purchasing an individual health insurance plan, but it will only last for a certain amount of time, which is outlined in the notice of continuation coverage after an employee loses their benefits.
Information Source: United States Department of Labor (http://www.dol.gov/dol/topic/health-plans/cobra.htm)

Critical Care Insurance is a limited benefit health insurance policy intended to provide coverage for a critically ill patient. Because critical care insurance falls under a limited benefit policy, the insured patient will only receive coverage in the event that a critical care diagnosis has been met. Typically critical care conditions are life-threatening and will require comprehensive care and monitoring. Critical care insurance is often purchased as a supplemental policy to a traditional health insurance plan in order to cover critical care benefits that the traditional health plan may lack.
Information Source: National Association of Insurance Commissioners (www.naic.org)

Disability Income Insurance is a type of coverage option that provides weekly or monthly benefit payments while the policyholder is disabled resulting from a covered injury or an illness. The disability payment is typically a set amount that will not exceed a specified percentage of the covered person’s income. This type of policy provides added protection to the policyholder and typically will expire when eligible for Medicare.
Information Source: National Association of Insurance Commissioners (www.naic.org)

Effective date: is the actual date (month, day, and year) that an insurance policy begins. No coverage or benefits will take place until the effective date is reached. Effective dates will be disclosed by the insurance company and is not necessary the date in which the policyholder signs up for the policy. Furthermore, effective dates may be complicated by pre-existing condition period provisions. It is always important to know these dates for policy coverage and benefits.
Information Source: Health Insurance Resource Center (www.healthinsurance.org)

Elimination Period: also known as waiting period, the elimination period is amount of time between the beginning of an injury or illness and when the policyholder receives the benefits as explained in the policy. An elimination period is generally found in disability health plans. If expenses are occurred during the elimination period, the policyholder will pay for those out of pocket expenses. In this way, the elimination period is also seen as a deductible for the insurance policy, as there is no reimbursement once the elimination period has expired.
Information Source: Insurance Information Institute (www.iii.org)

Exclusion: is a medical service that is not covered under an individual’s insurance policy. Exclusions, which may also be referred to as limitations, may include certain medical conditions, diseases, or physician, specialty, or hospital related care services that are not included in the policy. Exclusions will be provided in the paperwork for the policy benefits and coverage allowances.
Information Source: United States Department of Health & Human Services, Agency for Healthcare Research and Quality (www.ahrq.gov)

Explanation of Benefits: is a written explanation from a policyholder’s insurance company for a claim detailing what the insurance company paid and what the patient must pay. An explanation of benefits is sent to the policyholder not in the form of a bill rather it is a statement showing the service performed by the provider as well as the amount paid by the health plan. The policyholder should then send the remaining portion of the bill to the provider. If a service is entirely covered by the insurance company, the policyholder will not receive an explanation of benefits, as it will only be sent for unpaid claims and balances. The explanation of benefits will also provide the information for appealing the claim.
Information Source: Health Insurance Resource Center (www.healthinsurance.org)

Gap Insurance is a supplemental insurance plan that policyholders take out in addition to a main health insurance plan. Gap insurance is intended to provide added coverage in order to compensate for a specific area of coverage. An example of gap insurance is a Medigap policy, which is a Medicare Supplement insurance policy sold by a private insurance company designed to fill in the gaps of an original Medicare policy coverage. In the event that a traditional health insurance policy does not provide enough coverage, a gap insurance plan will provide the additional coverage.
Gap insurance can also apply to coverage obtained during a temporary or brief loss in regular health insurance benefits. This may refer to a disability or job loss. In the case of job loss, Consolidated Omnibus Budget Reconciliation Act (COBRA) would be gap insurance when an employee experiences job loss or reduction in hours. COBRA is a continuation coverage insurance plan provided to employees while they are in a transition period and serves as gap insurance.
Information Source: Medicare (http://www.medicare.gov)

Gatekeeper Provision is a term commonly referenced in all Health Maintenance Organization (HMO) insurance plans. A policyholder selects a primary care physician to serve as the gatekeeper, or personal physician for all basic medical treatments and also to provide referrals to specialists outside of the primary care physician’s practice. Gatekeepers are the basic component of the HMO structure and therefore do not exist in a Preferred Provider Organization (PPO) plan or other indemnity health plans where policyholders are free to select any physician or specialist without a referral.
Information Source: Texas Health Options, A Service of the State of Texas (http://www.TexasHealthOptions.com)

Group Health Insurance is a type of health insurance offering coverage to employees, student organizations, professional associations, religious organizations, or other related groups. Most often group insurance applies at the job level. Employers will offer a group health insurance plan to their employees, spouse, and dependents as one of the many benefits of working for their company. Group insurance is a benefit because the employer will pay a certain amount of the insurance premium cost, leaving the remaining premium amount to the employee. Group insurance is offered at a discount or fraction of the cost of an individual health insurance plan. An employee must meet an eligibility requirement in order to receive the group insurance rate. Typically, eligibility is based on hours worked per week, job level or classification, or overall time the employee has been with the company. Another benefit of group insurance is the continuation of coverage for a period of time that an employee receives once they leave the company. For more information, please see Consolidated Omnibus Budget Reconciliation Act (COBRA).
Information Source: Texas Health Options, A Service of the State of Texas (http://www.TexasHealthOptions.com)

Guaranteed Issue Insurance refers mainly to a group market whereby an applicant cannot be denied access to a health insurance plan. Unlike underwritten health plans where an applicant is determined to be a risk or a necessity for a higher premium, a guaranteed issue insurance plan imposes the restriction that a company must provide coverage for an employee regardless of lifestyle or medical factors. The company is required to provide the employee coverage at the same rate as all other active employees so long as they fulfill the requirements for obtaining the group rate. Guaranteed issue insurance mostly applies to a group market and is seldom invoked in an individual health insurance plan.
Information Source: Council for Affordable Health Insurance (www.cahi.org)

Health Maintenance Organization (HMO) is a type of major medical policy designed to provide assistance with covering medical expenses. With a HMO plan, the policyholder will choose a primary care physician from a list of approved network providers. A policyholder’s primary care physician is responsible for the management of his or her healthcare needs. If the policyholder requires the use of a specialty care physician, such as a dermatologist or ENT (ear, nose, and throat) specialist, they would see their primary care physician for a referral. All referrals must come from the primary care physician and must be network specialists in order for an HMO claim to be filed and paid. Treatment outside of the network is usually at the policyholder’s expense or paid on a percentage of the cost through the HMO.
Information Source: National Association of Insurance Commissioners (www.naic.org)

 

Health Savings Account (HSA) is a savings product offering consumers an alternative to a traditional health insurance plan. Enrolling in a HSA allows consumers to contribute money tax-free for health expenses and save for future expenses. In order to qualify for a HSA, a person must be covered by catastrophic insurance, or a high deductible health plan (HDHP). Catastrophic insurance is a more affordable option than a traditional health insurance plan. The idea is to send the money that is saved by having catastrophic insurance rather than a traditional health plan into a HSA. By contributing to a HSA, the consumer takes advantage of putting their savings to use by determining how the money is spent and what type of investments to make with the money. Consumers are able to sign up for a HSA with an insurance company, bank, credit union, or usually with an employer. Since there are no fees or costs associated with a HSA, other than having catastrophic insurance, the consumer chooses how much money to put into the HSA.
Information Source: United States Department of the Treasury, (http://www.ustreas.gov/offices/public-affairs/hsa/)

Hospital Insurance is a limited benefit insurance policy that is designed to cover hospital expenses that the policyholder incurs. Hospital insurance will cover the policyholder for a certain period of time usually not less than 31 days. Hospital insurance will cover continuous in-hospital care and certain outpatient services. With a hospital insurance plan, the policyholder will only be covered for the expenses they incur while admitted to the hospital.
Information Source: National Association of Insurance Commissioners (www.naic.org)

In-network: refers to a provider or facility that belongs to a health plan’s network of providers. The provider has negotiated a discount with the health insurance company in order to pass the savings along to the patient. Providers in the networks have contracts with the insurance companies and when a patient visits an in-network provider, there is usually less cost for their services. Health insurance plans such as a HMO and PPO rely on the network system for their policyholders.
Information Source: Health Insurance Resource Center (www.healthinsurance.org)

Independent Review Organization (IRO): refers to an independent body assigned to review the decision of a claim not paid for by a health insurance company. If the insurer does not pay for a healthcare service that the policyholder deems medically necessary, the policyholder must appeal before submitting the claim to the IRO, except when the condition is life threatening or time-sensitive. The IRO will review the original decision and may uphold it or determine a new decision. If the IRO agrees with the claimant, the health insurance company is required to pay for the treatment needed under the new decision. The IRO is completely independent of the health plan or insurance company and therefore considered objective.
Information Source: Texas Health Options, A Service of the State of Texas (http://www.TexasHealthOptions.com)

Long-Term Care Insurance is a type of medical insurance policy that provides coverage for a policyholder that requires long term-care or assistance because of extended illness or disability. Long-term care insurance provides a fixed monetary amount while a person receives the care. A long-term care insurance policy will pay for skilled, intermediate and custodial care in a nursing home, patient home, adult day care center, hospice, or assisted living facility. A long-term care insurance policy is paid with a monthly premium and then activated once the policyholder needs access to long-term care. Many long-term care insurance policies will have a pre-existing condition clause that requires the patient to pay out of pocket if the pre-existing condition requires medical advice or treatment within a time frame after the policy goes into effect. Some insurance policies do not have a pre-existing condition clause, but it is important to check the specifics of the long-term care insurance policy to determine if the policyholder falls into the pre-existing condition category. There are several reputable sources of obtaining a long-term care insurance policy, including through group or association membership, employer, federal or state government, or through a life insurance policy.
Information Source: National Association of Insurance Commissioners (www.naic.org)

Major Medical is a health insurance classification that covers serious illnesses or injury when the costs of treatment are too high. Under a major medical insurance policy, medical expenses are paid after the policyholder pays a deductible or coinsurance and coverage costs are usually paid up to a pre-determined maximum limit. Typically physician and specialist visits, hospital and emergency room care, and prescription drugs cost are covered in a major medical insurance policy. Examples of a major medical policy are Health Maintenance Organization (HMO), Preferred Provider Organization (PPO) or other indemnity insurance programs.
Information Source: National Association of Insurance Commissioners (www.naic.org)

Medicare is a government-sponsored program that provides health care assistance and insurance for people over 65 years old and for disabled people under 65 years old. Medicare covers certain medical services and supplies in physician offices, hospitals, or other healthcare settings. Medicare is a fee-for-service plan where a deductible applies. Medicare is comprised of two parts: Medicare Part A (hospital coverage) and Medicare Part B (medical coverage). Medicare hospital insurance covers patients with inpatient care in hospitals and rehabilitation facilities, home health care, hospice, and skilled nursing facilities. Medicare medical insurance covers medically necessary services such as physician visits, outpatient care, and preventive services, such as diabetes screening.
Information Source: Medicare (http://www.medicare.gov)

Medicare Advantage Plan is a privately managed healthcare plan that provides additional benefits to the Original Medicare Plan. The additional benefits are provided for a monthly fee and are similar to traditional health coverage plans like a Health Maintenance Organization, Preferred Provider Organization, Medicare Special Needs Plans, or any fee-for-service plan. Medicare Advantage Plans usually also include prescription drug coverage. In order to join a Medicare Advantage Plan, the policyholder must have Medicare Part A (Hospital) and Medicare Part B (Medical). It is also important to note that with a Medicare Advantage Plan a Medigap policy will not pay any deductible or co-payment under the Medicare Health plan.
Information Source: Medicare (http://www.medicare.gov)

Medicare Supplement is an additional insurance coverage plan that pays expenses that are not covered in the Original Medicare Plan. A Medicare supplement policy helps cover the expenses such as deductibles. A Medicare supplement insurance plan is considered a gap insurance, or Medigap plan, because its purpose is to provide the policyholder with additional coverage.
Information Source: Medicare (http://www.medicare.gov)

No Pre-Existing Condition allows policyholders with a prior illness or injury to seek medical care the day the insurance policy goes into effect. If a plan had a pre-existing condition clause, then a policyholder would have a waiting period before seeking medical treatment or advice from a physician because it would not be covered by their health insurance plan. With a no pre-existing condition clause, a policyholder does not have a waiting period and may use their policy for any prior conditions on the day it goes into effect. Health insurance shoppers should check with their potential insurer to learn about pre-existing condition periods, as all insurance companies will vary on pre-existing conditions.
Information Source: National Association of Insurance Commissioners (www.naic.org)

Point of Service (POS) is a type of major medical plan designed to strike a balance between a Health Maintenance Organization (HMO) and a Preferred Provider Organization (PPO). A POS plan provides more flexibility than a HMO, but will require the policyholder to select a primary care physician. Much like a PPO, a patient can see an out of network provider at his or her own cost. However, if the primary care physician makes a referral to an out of network doctor, then the patient will be fully covered by their health plan.
Information Source: National Association of Insurance Commissioners (www.naic.org)

Open Enrollment: is a fixed time of the year when a potential insurance plan applicant can enroll in a health insurance plan. It is also when an existing policyholder can change or drop their plan without meeting the requirement for a qualifying event to change a health insurance plan. Open enrollment periods usually occur at the end of the calendar year and subsequent additions and changes take place at the beginning of the following calendar year. Open enrollment periods are commonly associated with group insurance plans.
Information Source: United States Department of Health & Human Services, Agency for Healthcare Research and Quality (www.ahrq.gov)

Out of Network: describes physicians, hospitals, or providers that are not within the health insurance company’s network of accepted providers. Services rendered at any of the non-participating providers typically will cost the patient more and some insurance policies will exclude them altogether. A policyholder may visit the out of network provider, but it may be at partial or total expense. The insurance company will provide a list of accepted In-Network providers. Any provider not on that list at the time of service will be considered Out of Network and coverage will fall under the ‘Out of Network’ costs and benefits.
Information Source: Texas Health Options, A Service of the State of Texas (http://www.TexasHealthOptions.com)

Out of pocket Maximum: is an amount of money that a policyholder will pay before full coverage is provided by the insurance company. The amount is determined and defined when the policy goes into effect. The Out of Pocket Maximum will also be included in the explanation of benefits for a claim. Once the Out of Pocket Maximum is reached, the insurance company will cover 100% of an individual’s expenses. The Out of Pocket Maximum is assessed yearly and provides the policyholder with an estimate of the maximum an individual will pay for services, deductibles or co-pays over the course of the year.
Information Source: Health Insurance Resource Center (www.healthinsurance.org)

Point of Service (POS) is a type of major medical plan designed to strike a balance between a Health Maintenance Organization (HMO) and a Preferred Provider Organization (PPO). A POS plan provides more flexibility than a HMO, but will require the policyholder to select a primary care physician. Much like a PPO, a patient can see an out of network provider at his or her own cost. However, if the primary care physician makes a referral to an out of network doctor, then the patient will be fully covered by their health plan.
Information Source: National Association of Insurance Commissioners (www.naic.org)

Pre-Authorization is a process where a healthcare professional determines the medical necessity of an intended treatment for a patient. The healthcare professional will evaluate the necessity, level of care, and procedure and recovery treatment facility. Much like pre-certification, pre-authorization is intended to determine medical necessity only and does not guarantee that a patient will be fully insured with their health insurance plan.
Information Source: Council for Affordable Health Insurance (www.cahi.org)

Pre-certification is an eligibility requirement set by a healthcare plan that must be fulfilled in order to be approved for certain medical procedures. Pre-certification approval indicates that the procedure is medically necessary for the patient and must be done well in advance of the procedure. Pre-certification does not indicate that the procedure will be covered monetarily by the patient’s insurance policy.
Information Source: Texas Health Options, A Service of the State of Texas (http://www.TexasHealthOptions.com)

Pre-Existing Condition is defined as an illness or injury that a person has received medical advice, recommendations, diagnosis, prescription drugs or treatment for prior to signing up for a new insurance policy. If a potential policyholder has a pre-existing condition then treatment or advice from a physician may not be covered by their health insurance policy for a certain period of time after the policy goes into effect. The pre-existing condition waiting period may range from 6 months to 12 months. Many insurance companies may require a longer period or none at all. Health insurance shoppers should check with their potential insurer to learn about the pre-existing condition waiting periods, as all insurance companies will vary on pre-existing conditions.
Information Source: National Association of Insurance Commissioners (www.naic.org)

Preferred Provider Organization (PPO) is a type of medical policy plan designed to provide assistance with covering medical expenses. Unlike a HMO plan, a PPO plan allows the policyholder to choose any physician or specialist in their network without a referral. Policyholders are able to change doctors at any time and also see a specialist without requiring a referral from the primary care physician. Insurance companies are able to provide this plan because they have contracts with their network hospitals and doctors to provide the service at a discounted rate. As long as the policyholder uses providers within the network, the insurance company will reimburse to the maximum for the service. A policyholder is still able to see an out of network provider, but the out of pocket expense will be higher.
Information Source: National Association of Insurance Commissioners (www.naic.org)

Reinsurance: refers to an insurance company that assumes some of the risk involved in the underwriting of another insurance company. The insured insurance company then provides total coverage for an individual or employer. Reinsurance more commonly takes place with employer provided insurance, as the insurance risk of individuals is not entirely known at the time insurance is offered. This process allows the insured insurance company the opportunity to alleviate some of that risk.
Information Source: United States Bureau of Labor Statistics (www.bls.gov)

Rider: is an addition or modification to an insurance plan. Usually a rider exists to supplement certain clauses, provisions, or exclusions of a policy. Riders can add coverage or exclude coverage. An insurance company or the policyholder can issue at rider to the original policy.
Information Source: Health Insurance Resource Center (www.healthinsurance.org)

Student Insurance is a type of insurance policy targeted to college or graduate level students. Student insurance is particularly effective when a student is no longer or unable to remain covered on a parent’s insurance policy or when a student has limited coverage on a parent’s policy because they are out of their policy network’s service area. Student insurance plans are available through a college or university and vary in coverage. A license insurer provides the college with the plans and they are available for a specific period of time, usually a semester or school year. Coverage benefits for a student health insurance plan are more limited and may have more provisions and exclusions than a traditional health insurance plan.
Information Source: Texas Health Options, A Service of the State of Texas (http://www.TexasHealthOptions.com/cp/students.html)

Surgical Insurance is a limited benefit insurance policy that is designed to cover medical and surgical expenses that the policyholder incurs while undergoing a necessary surgery. Surgical insurance will cover the policyholder’s in-hospital care for a certain period of time, usually not less than 21 days. With a surgical insurance plan, the policyholder will only be covered for a surgery that is deemed necessary and not elective.
Information Source: National Association of Insurance Commissioners (www.naic.org)

Third-Party Administrator (TPA): is an entity designed to administer employee benefits for a company. The employer hires the TPA to maintain the business of employee benefits, including processing claims, paying providers, administering appropriate paperwork, and handling all operations details for the benefits.
Information Source: United States Bureau of Labor Statistics (www.bls.gov)

Viatical Settlement: typically refers to the sale of a life insurance policy while the policyholder is still alive. An insurance company or firm will buy the life insurance policy from the policyholder at a discount in order to provide the living policyholder with a payout to use on treatments and prescriptions not covered under a health insurance plan. This settlement is primarily desirable for individuals with no health insurance coverage or a limited benefit health insurance plan. Also, since the life insurance policy is sold and rendered inactive, there is no beneficiary or surviving dependent that can receive any portion of the policy.
Information Source: Insurance Information Institute (www.iii.org)

Underwritten Health Plans are those involving the assessment of an insurer to determine the risk of a potential policyholder applicant. The underwriter looks at a variety of criteria when determining the health plan premium for the applicant, including but not limited to pre-existing condition, potential for costly medical condition, or health lifestyle. In some cases, an applicant may be denied coverage. The sole intention of underwritten health plans is to balance the affordability factor among applicants who are most at risk for expensive medical care and those that are not. This type of health plan is contrary to a guaranteed issue health plan that requires a company must accept any applicant into the plan regardless of the above-mentioned factors.
Information Source: Council for Affordable Health Insurance (www.cahi.org)

Waiting Period: is a period of time that occurs between the issue date of a policy and when the coverage benefits for the policyholder are provided. For example, an individual may sign up for insurance plan in October but the policy will not go into effect until January. The time between October and January is called the waiting period. This period of time is also referred to as an elimination period or probationary period. During the waiting period, the individual is not covered for any services and will not be reimbursed once the policy goes into effect.
Information Source: Insurance Information Institute (www.iii.org)

Yearly Premium: is the amount of money an insurance company will charge an employer or group for covering health plans for its members. The employer will then charge its employees a percentage of that cost and pay the remaining difference. A yearly premium almost always refers to group insurance and it is one of the many benefits of having a group insurance plan. A yearly premium covered in part by the group, employer, or organization provides a cost savings benefit to the individual policyholder.
Information Source: National Coalition on Health Care (www.nchc.org)