Health Insurance Daily Guide

Pre-Existing Condition
An illness or condition which was treated or diagnosed before the policy was issued. Many policies will not pay benefits for pre-existing conditions, or will only cover treatment of them after the policy has been in force for a specified period of time. This varies based on whether the policy is group or individual coverage.

Renewal and Premium Increase
Determine the conditions under which your policy may be renewed or the premiums increased. Ask what type of renewal provision applies to your policy.

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Effective Period
The date health insurance protection begins.

Elimination Period
Specified number of days that you must be eligible for coverage or disabled before the policy begins to pay benefits.

Exclusions and Limitations
Conditions or circumstances in which benefits are not payable or may be limited. Some examples of exclusions are suicide or self-inflicted injuries, injuries resulting from war, on-the-job accidents covered by workers’ compensation, eye or dental treatment, cosmetic surgery, services for which no charge is made, and services that are not medically necessary. Some policies also may place limitations on or exclude treatment of mental illness or substance abuse.

Source: ins.state.pa.us

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Coinsurance
The share of your covered expenses, usually a percentage, you must pay after the deductible is reached. For example, a policy may require you to pay twenty percent of the cost up to a certain dollar amount.

Conversion of Privileges
Allows the participant or beneficiaries to convert coverage to a different plan of insurance without providing evidence of insurability. The privilege granted by a group policy is to convert to an individual policy upon termination of group coverage.

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Health Maintenance Organizations (HMOs) are prepaid health plans. A typical HMO provides a broad range of services. A monthly premium for coverage is either paid by the individual or his employer. Coverage is usually for general physical exams and other types of services that are not covered by other insurance plans. Some HMOs have big medical clinics, provided with doctors, nurses and therapists on board. You can choose a physician from the organization’s roster to coordinate your medical treatment. HMOs tend to provide the least expensive medical coverage and a minimum of paper work, but, the choice of physicians may be more limited.

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