Demystifying Health Insurance

Are you confused by insurance terms such as OOPM, Deductible, co-pays, and other terms? Then this article is for you. Connected Family Services does accept health insurance as a benefit to the people we serve. We know that health insurance contracts can have a lot of terminologies that can be difficult to understand so we wanted to share about it in user-friendly terms. Please message us with any questions and we will be happy to answer.

• Premiums: The monthly cost to have health insurance that will be paid out of pocket or be debited out of employer paycheck. This does not go towards the out of pocket max.

• Deductibles: The amount an individual has to pay yearly for non-covered service before the insurance will cover all or a percentage of that service. Call the number on the back of your insurance card to verify that mental health services (or the service you need) are a covered service. If it is not, you will be responsible for the full cost of that service until the deductible is met.

• Co-Pays: The set amount per service that a person is responsible for in reference to covered services. This amount is usually different for primary care providers versus specialist visit. Mental Health services are usually considered a specialist visit under many insurance plans.

• Co-Insurance: A percentage that you would be responsible for in reference to non-covered services after the deductible is met. So if you have a 10% co-insurance and a $1,000 deductible, you would have to pay for services in full until you reach the $1,000 then the services would be covered at 90% and you would be responsible for 10%. So in this example, if you have met your deductible and the service cost $100 then you would be responsible to be $10 after the deductible is met. Prior to the deductible being met, you would be responsible for the full $100.

• Out of Pocket (OOP) Max: This is the max that a person would be responsible for paying in a given year. This does not include the cost of premiums but does include the cost of co-pays, deductibles, and co-insurances. Generally, health plans will then pay all remaining services at 100%.

• Out of Network (OON): This means that a provider or facility does not have a contract with your insurance company. Some insurance companies will provide OON benefits but this is generally a separate benefit from the items explained above.

Please feel free to ask any questions or request clarification even if you are not a current client. We will be happy to help where we can or put you in the right direction.