Understanding Your Health Insurance

What is health insurance? Health insurance is a contract between you Understanding Your and your health insurer to cover your medical expenses. Your health insurance company helps Health Insurance pay for some or all your medical care, depending on the type of insurance plan you have. What payments are required before or at the time of service? UW Health assists our patients by researching your coverage and benefits directly with insurance companies to better understand what you may owe. We ask that you pay your estimated out-of-pocket liability (copayment, co-insurance, deductible) prior to service. When we ask for an estimated prepayment, it is not the exact amount that you may ultimately owe. Due to the personalized nature of medicine, patient differences, and the potential for unforeseen complications, it is only an estimate. After your insurance processes the claim, you will either be billed any remaining amount due or refunded any overpayment. Please note if you have any patient balances for other dates UW Health is committed to providing of service, your overpayment will be applied to remarkable care and service to our those balances. patients and families. This includes helping you understand what health What if I cannot pay before or at the time insurance is and explaining some of service? common health insurance terms. UW Health will not deny access to emergent or urgent care. We will work with you to assure that If you have questions about your you receive the care you need when you need it. coverage, we encourage you to check Our team of financial counselors can work with with your insurance company. you to review government program eligibility, set up payment plans, identify other possible coverage options, and discuss our financial assistance program where applicable. For assistance, please call (877) 565-0505. uwhealth.org HA-188975-18 uwhealth.org Health Insurance Terms A Premium is the amount that must be paid for A Copayment, or copay, is an amount you are In-Network refers to select groups of doctors, your health insurance or plan. You and/or your required to pay as your share of the cost for a hospitals and other healthcare professionals who employer usually pay it monthly, quarterly, or medical service, like a doctor’s visit or prescription are contracted with your insurance to provide a yearly. It is not included in your deductible, your drug. A copay is usually a fixed amount, rather than full range of covered healthcare services. copayment, or your co-insurance. If you don’t pay a percentage. your premium, you could lose your coverage. • To keep costs low when • Contact your insurance • For example, you might • You may have different using your plan, you’ll want company to find out A Deductible is the amount you owe for healthcare pay $20 for a doctor’s copayments depending to make sure you stay which providers are services your health insurance or plan covers visit, lab work, or on the type of service. “in-network.” If you visit “in-network.” These before your health insurance begins to pay. prescription For example, a a doctor outside of your providers may also copayment for a visit to network, you may have to be called “preferred- • For example, if your an emergency department pay more for your care. In providers” or deductible is $1,000, may be different than a some cases, you may have “participating providers” your plan won’t pay Insurance starts to pay copayment for a visit with for covered services to pay the full cost anything until you’ve paid your primary care doctor the first $1,000 toward above deductible (copays and co- Amount paid your healthcare services. insurance still apply) Deductible by insurance In-Network • The deductible may not Amount you pay apply to all services. You Amount before insurance will want to check with begins to pay you pay Copay Copay = $ your insurance company Copay for any exclusions Medical expenses Offce visit Hospital Prescriptions Out-of-pocket maximum is the most you’ll have Co-insurance is your share of the costs of a to pay for covered services in a benefit year. ▲ preferred providers ▲ covered healthcare service, calculated as a percent After you reach this amount, your health plan (for example, 20%) of the total cost for the service. will pay for all covered health benefits from an You pay co-insurance after you have met your in-network provider. Out-of-Network deductible. • This limit includes • This limit does not have f off ce • For example, if the st o visit deductibles, co- to include premiums co : $ al 1 insurance, copayments, or spending for non- health insurance or t 00 = $$$$ To plan’s allowed amount Amount or similar charges and essential/elective health for an office visit is you pay: any other expenditure benefits. $100 and you’ve met $20 required of an individual Insurance pays your deductible, your for a medical expense for all covered co-insurance payment ▲ non-preferred providers ▲ services above of 20 percent would Amount paid your maximum be $20. Your health by insurance: $80 amount Allowed Amount is the amount that your health insurance pays the Maximum out-of-pocket insurance or plan will pay for a particular service. rest of the allowed The maximum The allowed amount can be different for in-network amount. amount you will versus out-of-network providers and facilities. have to pay in the beneft year Medical expenses.

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