★Insurance Words

1. Preferred Provider Organization(PPO)                             2. In-Network

3. Out-of-network                                                                  4. Deductible

5. Co-insurance                                                                    6. Co-pay

7. Overall Plan Maximum                                                     8. Out-of-Pocket Maximum

9. Preventative Care                                                           10. Prescriptions Drug 

11. Pre-existing Condition                                                   12. Emergency Room

13.EOB(Explanation of Benefits)                                        14. Insured

15. Procedure code                                                            16. Amount claim

17. Ineligible                                                                       18. Total covered

19. Patient balance                                                             20. Pharmacy  

21. Premium                                                                        22. Primary Care Clinic

23 .Urgent Care                                                                   24. Tier Drug

★Important medical insurance terms

Premium:

 Regularly paid insurance fee.

Co-Pay: 

Similar to the registration fee in China, it is paid for each hospital visit. The amount of co-pay varies depending on your insurance type and your medical condition.

Deductible:

The amount you must pay out of pocket. For example, if your deductible is $1500, you must cover all medical expenses within this amount. Any costs beyond $1500 will be shared between the insurance company and the insured on a proportional basis. Therefore, the lower the deductible, the higher the premium.

Co-Insurance: 

After reaching the deductible amount, you need to pay a percentage of the costs. For instance, if you choose 30% co-insurance, and a medical expense is $100, the insured only pays $30, and the insurance company covers the remaining $70.

Out-of-Pocket Maximum/Limit: 

The maximum amount you need to pay out of pocket for the entire year. Once this limit is exceeded, the insurance company covers the remaining medical expenses in full. This is cumulative, meaning, for example, if the out-of-pocket max is $10,000 and the combined deductible and co-insurance for various medical bills in a year amount to $25,000, you only need to pay $10,000, and the remaining $15,000 will be covered by the insurance company.

In-Network & Out-of-Network:

 In-network hospitals are those contracted with the insurance company, while out-of-network hospitals are not contracted. It's important to note that the cost-sharing ratio for in-network and out-of-network hospitals may differ. For example, in some insurance policies, the insurance company covers 80% of in-network hospital expenses but only covers 60% of out-of-network hospital expenses.

★The Differences Between With HMO EPO PPO  

HMO ( Health Maintenance Organization )

Insurance premiums are relatively cheaper, the proportion of out-of-pocket expenses for medical treatment by insured persons is relatively low. The plan requires policyholders to designate a family doctor and only reimburses services provided by clinics and doctors within the HMO network, and will not reimburse any out-of-network services except for emergencies. In addition, except for emergency departments and obstetrics and gynecology, all specialist consultations need to be referred by a family doctor, otherwise the medical expenses will not be reimbursed.

EPO (Exclusive Provider Organization )

The flexibility and choice are higher, as policyholders are no longer required to designate a primary care physician. Additionally, this plan only reimburses services provided by clinics and doctors within the EPO network, with the exception of emergencies, and does not cover any services outside the network.

PPO(Preferred Provider Organization )

The flexibility is higher, and both premiums and out-of-pocket expenses are typically higher. This plan covers a significant portion of medical service expenses. Policyholders are not required to designate a primary care physician, and referrals from a primary care physician are not needed. When receiving medical services within the network, the individual's out-of-pocket expenses are lower. However, when seeking services outside the network, policyholders typically pay a higher percentage of the costs, often around 50%.