Health Literacy

We know that selecting a health insurance policy is confusing. That’s why we pulled together this 3-part Understanding Health Insurance blog post series.

The vocabulary (which was discussed in part one) is enough to make you want to pull your hair out. But on top of all the confusing terms, Health Insurance companies insist on using what feels like an endless number of acronyms. We have selected the most commonly used insurance acronyms below to provide you with the knowledge to make the best decision related to the policy you need.

• HMO – Health Maintenance Organization
  • Generally recommended for those who do not have preexisting conditions. An HMO is an organization that requires the policyholder to select a primary care physician (PCP) and then only receive treatment and care from physicians and specialists within that established provider network.
  • In this type of plan, policyholders are limited to only visiting physicians or specialists recommended by the PCP. Visiting a healthcare provider not recommended by the PCP can result in paying all out-of-pocket expenses.
• EPO – Exclusive Provider Organization
  • Very similar to an HMO, however there is more flexibility as a PCP does not need to be designated with this type of plan. Policyholders have a network of physicians and specialists to choose from and do not have to wait for a referral from a PCP.
  • Similar to the HMO, going outside the network will result in paying higher out-of-pocket costs.
• PPO – Preferred Provider Organization
  • Almost exactly the same as the EPO. The major difference being that PPOs cover visits to out-of-network providers at a higher rate. While EPOs do not cover visits to out-of-network providers at all.
  • PPOs are often recommended for individuals who require regular visits to physicians or specialists outside of your plan’s network.
• POS – Point of Service Plans
  • Similar to an HMO, a PCP must be appointed to receive treatment and referrals to other physicians and specialists within their provider network. The difference in a POS plan is that a PCP can refer patients to out-of-network healthcare providers and while the out-of-pocket expense may be higher, a POS will cover some of the expense.

Stay with us, these next three get a little confusing. All of the below accounts/arrangements work in tandem with a traditional health plan or high deductible health plan. All are tax deductible for the policy holder, employer or both – if being used for medical expenses.

• HSA – Health Savings Account
  • This is an account used solely to save money that is used for future medical expenses. Part of your monthly premium contributes to the HSA but you, your family, or your employer can also contribute to the account. You must have a high deductible health plan to sign up for an HSA. These funds never expire – even if you change jobs, health plans, or retire.
  • If money is pulled out of this account for non-medical expenses, the amount must be included in the policy holder’s gross income on their tax return and may be subject to a tax penalty of 20%.
• HRA – Health Reimbursement Arrangements
  • Unlike the HSA, a HRA is maintained by an employer on the policy holder’s behalf. This is a savings account used exclusively to generate funds to reimburse medical expenses. The employer contributes money into the fund and after paying a medical expense, policy holders submit documentation of the payment for reimbursement.
  • The employer determines a set budget for monthly reimbursements.
• FSA – Flexible-Spending Account
  • FSA accounts are managed by the policy holder and they make regular contributions via paycheck deductions (which cannot exceed $2,850/year)
  • FSA funds typically cover a wider range of medical expenses and medications.
  • The funds in this account are typically a “use it or lose it,” meaning account holders must make use of the funds while it is active. Recent amendments have allowed employers to opt into allowing policy holders to roll over up to $500 of unused funds into the next year’s plan. If selecting this plan, pay close attention to the terms and conditions to see if your employer opted into this option.

The Student Health Insurance at Ohio State has a PPO coverage model. This means that students on the plan have access to a wide range of in-network providers and facilities in Franklin County while also having a large national network outside of the area available for coverage. One of the many benefits to attending Ohio State is access to a world renown medical center within walking distance to our campus.

As we head into a new year, make a wellness goal around staying up to date on preventative healthcare appointments. Check your plan and schedule your next doctor’s appointment for 2023!

As stated in our previous post, Ohio State students are required to hold some kind of health insurance. If you are an international student, you are required to sign up for insurance through the Student Health Insurance policy. If you are a domestic student enrolled in a degree program and enrolled in at least six (6) credit hours for undergraduates, at least four (4) credit hours for graduate and professional students and at least three (3) credit hours for post-candidacy doctoral students are automatically enrolled in this insurance plan. Domestic students have the option to withdraw from the Student Health Insurance plan if they have coverage elsewhere. For more information on Student Health Insurance visit the Student Health Insurance website and read their FAQs page for answers to common questions.

References:

Health Insurance Literacy: Student Health Insurance (osu.edu)

Understanding Health Insurance (medicalbillingandcoding.org)

HSA vs. FSA vs. HRA – Healthcare Account Comparison (healthequity.com)

-Jordan Helcbergier, Wellness Coordinator

Navigating the healthcare system in the United States is challenging to say the least. Part of this is due to the confusing health insurance system in our country. What is a deductible? How much is my co-pay? What does out-of-pocket maximum mean? To make sure you are making the correct choice when selecting a health insurance plan, it is crucial to learn how health insurance works and what to look for when purchasing coverage.

This is part 1 of a 3-part blog post. Read below to learn more about key terminology you will want to know when selecting your health insurance policy.

Words to know and look for:

• Insurance Policy – a contract between an individual and an insurance company detailing everything that is covered by a health insurance plan, including the terms and conditions. Most insurance policies operate on a yearly contract.
• Policy Holder – the individual(s) covered by the health insurance policy.
• Dependent – a person who is eligible for coverage under a policyholder’s health insurance plan. A dependent may be a spouse, domestic partner, or child.
• Premium – the amount you pay per month or per year to the insurance company for healthcare coverage.
• Deductible – the amount you pay out-of-pocket during a policy year for some benefits before coverage starts. Once you hit a specific dollar amount out of pocket in that year, your insurance will start to pay its share.
• Co-pay – the amount you pay at the time of service. Example: paying $30 every time you visit your doctor or paying $50 each time you see a specialist for care. The actual dollar amount differs per plan but most often this cost is standardized by the plan you select.
• Out-of-Pocket Maximum – the maximum amount of money you pay in deductibles and co-pays in a year before the insurance company starts paying for all covered expenses.
• In-Network – healthcare services and providers that are covered under your insurance plan. In-network providers are often the cheapest option for you as the policyholder.
• Out-of-Network – healthcare services and providers not covered by your insurance plan. Using services outside of your network often result in higher costs to you as the policyholder.
• Pre-Existing Condition – any chronic disease, disability, or other condition you have at the time of application. Any treatments related to pre-existing conditions often result in higher premiums.
• Waiting Period – when accepting a new job that offers insurance to employees, often (but not always) employer-sponsored insurance plans require the new employee to wait a certain amount of time before qualifying to enroll in their health insurance plan. This waiting period varies but usually lasts 90 days.
• Enrollment Period/Open Enrollment – this is the time window when you can apply for health insurance or modify your existing policy.
• Qualifying Life Event – outside of the enrollment period, a policyholder can modify their plan if they experience a qualifying life event. This includes – marriage, divorce, birth of a child, changes to individual/household income, or relocating out of state.

Health insurance provides you with peace of mind when taking care of your health. By signing up for the appropriate health insurance plan, you are making sure that you will not be stuck with paying for expensive medical costs out of pocket.

Individuals can obtain health coverage through two options: individual coverage or group coverage. Individual coverage is purchasing coverage directly from the insurance company. While group coverage is often provided through eligible employment or student status when an organization negotiates with the insurance company for coverage for a large amount of individuals.

Ohio State students are required to hold some kind of health insurance. If you are an international student, you are required to sign up for insurance through the Student Health Insurance policy. If you are a domestic student enrolled in a degree program and enrolled in at least six (6) credit hours for undergraduates, at least four (4) credit hours for graduate and professional students and at least three (3) credit hours for post-candidacy doctoral students, you are automatically enrolled in this insurance plan. Domestic students have the option to withdraw from the Student Health Insurance plan if they have coverage elsewhere. For more information on Student Health Insurance visit the Student Health Insurance website and read their FAQs page for answers to common questions.

References:

Health Insurance Literacy: Student Health Insurance (osu.edu)

Understanding Health Insurance (medicalbillingandcoding.org)

-Jordan Helcbergier, Wellness Coordinator