Learn More about Health Insurance
How does health insurance work?
A health insurance policy determines the types of medical services or benefits you are covered for, which doctors you can see, and what hospitals you can visit. Your plan also determines what you pay for care and services.
After purchasing a health plan, you can then visit a doctor or hospital in the OneHealth network. A network is a group of doctors, hospitals, and healthcare providers that work with a health plan like OneHealth. That means you only have to pay a certain amount for healthcare services instead of the full cost. By using in-network doctors and hospitals, you can keep your costs lower.
Health insurance is for preventive and event-based care – meaning you don’t have to wait until you’re sick to see a doctor. Preventive services like annual exams and flu shots are available to you at no additional cost.
What is Coinsurance?
A fixed percentage of the cost of your services that you’re responsible for. This is usually after you’ve met your deductible.
What is a Copayment?
A fixed amount you pay for benefits such as doctor’s visits or any wellness services. This is usually after you’ve met your deductible if your plan has one.
What is a Deductible?
The amount you pay each calendar year for most benefits before OneHealth begins to pay. Some benefits, such as preventive care, are covered before you meet your deductible.
What is an HMO?
A health plan where you choose a primary care physician (PCP) who treats you regularly. This includes preventive visits and referrals to specialists. You’ll need to see only other doctors or specialists in your PCP’s medical group. There is no coverage for services received from doctors who are outside your PCP’s network.
What is a Network?
A group of providers – including hospitals, doctors, specialists and other healthcare providers – that have agreed with OneHealth to provide benefits for a specified amount.
What is an Out-of-pocket maximum?
The most you are required to pay in combined deductible, copayment, and coinsurance amounts for all of the covered services each year.
What is a PPO?
A health plan in which members can choose to see any provider in the PPO provider network without a referral. Members also have the freedom to use non-network providers for most services if they are willing to pay a higher share of the cost.