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| Health insurance terms and definitions, as well as, sample health plan descriptions presented in this web site are all general in nature and are for informational purposes only. Your personal TN health insurance agent can best advise you as to the health insurance program that is best suited to your needs and your budget. Each health insurance company is responsible for the plan design and the premium for each plan. All terms and conditions of your own individual health insurance policy will apply. |
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TN Health Insurance
TN Health Insurance Basics-Health Insurance Terms-Plan Descriptions To Help In Selecting The Right Insurance Program For You.
| Before you buy individual health insurance in TN, there are some basic health insurance terms with which you, at least, need to be familiar: |
In TN health insurance, a "deductible" is that part of a covered medical expense that you pay before your health insurance plan will begin paying. Depending on your health plan's design, a "deductible" may apply to various types of medical services, such as, prescription drugs; specialized medical treatment; hospital admission; emergency room treatment; or other health services.
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In TN health insurance, a "co-payment" is normally a pre-determined amount you pay in addition to what the insurance company pays for medical services. A "co-payment" does not count toward satisfying your annual "deductible" and is usually required each time a particular medical service is rendered. A "co-payment" may apply to prescription drugs; doctor's office visits; emergency room treatment; or other medical services.
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In TN health insurance, "Co-Insurance" determines how much of covered medical expenses you pay and how much the insurance company pays, after any deductibles or co-payments. "Co-Insurance" is usually expressed as a percentage, like, 80%/20%; 70%/30%; 60%/40%; etc. In this example you would be responsible for 20%; 30%; or 40% of the covered medical expenses, up to your maximum out-of-pocket expense.
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In TN health insurance, the maximum "Out of Pocket" expense is a pre-determined maximum amount that you must pay before your health insurance plan will pay covered medical expenses at 100%. The maximum "out of pocket" is normally on an annual basis and is usually not affected by "co-payments"; prescription drug expenses; or mental health services expenses.
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The "lifetime maximum" in TN health insurance, is the total dollar amount that will be paid by your health insurance plan in your lifetime. Due to the high cost of healthcare today, this may be an important factor in selecting your health insurance plan.
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| Pre-existing Health Condition |
Insurance companies that underwrite health insurance in TN will define the term "Pre-existing" differently. Please pay close attention to the "Medical Limitations and Exclusions" of the health insurance policy you are considering. Normally, a "pre-existing" health condition is described as a sickness or injury which was diagnosed or treated, or which produced signs or symptoms that would cause an ordinarily prudent person to seek treatment, during a specified period of time before the effective date of health insurance coverage.
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