top of page

Understanding Insurance and Updates

With the new year in full swing, we want to remind you all that with a new year comes insurance updates. We encourage you to reach out to your insurance company and check that telehealth is still covered under your plan as insurance companies may be making changes to their policies. We know that insurance can be scary and difficult to understand. To help, we have provided some common insurance terms and what they mean down below.

  • Cost Sharing- A general term that refers to the cost for services covered by a plan or health insurance that you must pay out of your own pocket (sometimes called "out-of-pocket costs"). Copayments, deductibles, and coinsurance are all examples of cost sharing.

  • Deductible- Amount you owe for health care services that is covered by your health insurance or plan before your health insurance begins to pay. For example, if your deductible is $1,000, your plan won’t pay anything until you’ve met your $1,000 deductible for covered health care services.

  • Copayment- Fixed amount that you pay for a covered health care service, usually at the time of the service (also referred to as a copay.)

  • Premium- Amount that must be paid for your health insurance or plan. This may be paid by you and/or your employer on a monthly, quarterly or yearly basis.

  • Coinsurance- Your share of the costs of a covered health care service, calculated as a percentage of the allowed amount for the service. For example, if the health insurance or plan's allowed amount for an office visit is $100 and you've met your deductible, your coinsurance payment of 20% would be $20. The health insurance or plan pays the rest of the amount.

  • Effective Date- Date your insurance plan starts covering you.

  • Out of Pocket Limit- Highest amount you could pay during a coverage period (usually 1 year) for your share of the costs of covered services. After you meet this limit, the plan will usually pay 100% of the allowed amount.

  • Claim- Request for a benefit that is sent to your health insurer. This request is made by you or your health care provider for items or services you think are covered. A claim includes reimbursement of a health care expense.

Remember, if you are unsure about your specific plan ad what it entails, please reach out to your insurance provider for more information. Resources For comprehensive glossaries of health coverage and medical terms with examples of real-life situations, check out the following links:

Mental Health America also has resources and education about how insurance works and how to go about paying for mental health care:

NAMI breaks down the different types of health insurance options and describes who is eligible for each option and what mental health benefits each one typically covers:

UHC details their updates regarding telehealth services during COVID-19:

9 views0 comments


bottom of page