ClaimLinx specializes in various employer-paid health insurance services, such as traditional group health insurance, employer benefits consulting, supplemental insurance, and individual plan consulting. We are a full-service insurance agency dedicated to lowering your health insurance costs while providing employees with their desired health benefits plan.
In today’s blog, ClaimLinx explains common terms you may come across when reviewing our health insurance plan services.
If you have not looked at your health insurance coverage in the past, understanding health insurance terminology is one of the first challenges you may face. Using your health insurance benefits can be tricky if you do not know the difference between a copay and a deductible.
Health insurance terms:
- Premium: A premium is the amount an individual pays for health insurance every month. Some employer-paid benefits come at no cost to employees, while others have employees pay premiums at a lower cost. For example, an employer could pay $100 a month for a worker’s health insurance while the employee pays $75 per month for the rest. ClaimLinx finds the right balance between premiums and out-of-pocket expenses for health care when it comes to employees.
- Deductible: A deductible represents the amount someone pays for health care services, such as a doctor’s office visit or a trip to urgent care before the health insurance plan pays its part or the rest. For example, an employee’s deductible could be $500. After the person pays $500 for services, insurance may pay all or part of the rest of the healthcare services, thereby lowering someone’s overall healthcare costs for the rest of the year. The ClaimLinx Solution is a strategy that lowers the employer costs as well as out-of-pocket costs for workers, which saves everyone money.
- Copayment (Co-Pay): A copayment (commonly known as co-pay) is the fixed amount a person pays for certain health services. Depending on the plan, a person may be required to pay the copay before and/or after he or she has met a deductible. Copays contribute to a person’s out-of-pocket maximum calculation and may or may not be changed by meeting a deductible. For example, one plan may have a $30 copay for a visit to the doctor’s office but require a person to meet his or her deductible before emergency visits are charged at a $100 copayment. ClaimLinx determines optimal copayments for employees for their deductible.
- Claim: When you file a claim, you request payment for healthcare services covered by a health insurance plan. As a MERP administrator, ClaimLinx offers straightforward ways for employees to file claims for processing so they can receive their benefits on time. See how claims are processed using the ClaimLinx Solution.
- Marketplace: One service offered by ClaimLinx is letting individual employees shop for their personalized health insurance plans. This happens in a marketplace, sometimes called an exchange or health insurance marketplace, run by the state or federal government. A marketplace allows someone to put in their information through an online portal, and then they can view which plans they are eligible for on the marketplace.
- Authorization: Obtaining approval from the primary care physician as well as the health plan (depending on the plan’s specifications) before receiving health care services, such as visiting specialists, obtaining radiology scans, and undergoing surgical procedures.
With a good understanding of common healthcare terms, you should be able to shop for a health insurance plan without added stress. Choosing your health insurance policy empowers you to control your budget and medical care rather than getting stuck with a group insurance health plan that may not fit your needs.
ClaimLinx Experts Help You and Your Employees
Our expert health insurance consultants can help you and your employees wade through the jargon, options, and health insurance companies to find the best possible health coverage for everyone. Contact ClaimLinx or call our office at (800) 858-1772 to find out how we can save you between 20 and 40 percent on employer-paid benefits for your loyal workers.
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