Terms & Definitions
Let’s review some common health insurance terms, and introduce some of the terms we frequently use at MotivHealth – ‘MotivSpeak,’ if you will.
While you may be familiar with most of these terms, let’s examine what they mean and how they relate in context. Knowing these terms will help you better understand how your MotivHealth plan works and equip you to save more money in the long run.
COMMON HEALTH INSURANCE TERMS
Health insurance plans customarily have a premium, or a set amount that you pay regularly for insurance coverage. You and/or your employer usually pay it monthly, quarterly, or yearly.
An amount you could owe during a coverage period (usually one year) for covered health care services before your plan begins to pay. An overall deductible applies to all or almost all covered items and services. A plan with an overall deductible may also have separate deductibles that apply to specific services or groups of services. A plan may also have only separate deductibles. (For example, if your deductible is $1700, your plan won’t pay anything until you’ve met your $17000 deductible for covered health care services subject to the deductible.) In summary – Insurance coverage doesn’t immediately kick in. Most plans have a deductible, which is the amount you pay before health insurance starts paying for medical expenses.
After you reach your deductible, you enter the coinsurance phase. This means you pay a percentage of your medical costs and insurance covers the rest.
You won’t pay coinsurance forever. Each year, there is a maximum amount that you’ll ever pay out-of-pocket called the out-of-pocket maximum. After you’ve reached your max out-of-pocket for the year, insurance will cover everything after that!
When receiving medical care, on most plans, you’ll often pay what’s called a co-pay —A fixed amount (for example, $25) you pay for a covered health care service, usually when you receive the service. The amount can vary by the type of covered health care service. Not all plans have co-pays, including manyHSA-based plans.
The cost of care depends on whether your doctor is a part of your network or not. In-network doctors have agreed to contracted rates for their services. So you will likely pay less when you stay in-network.
You can contact MotivHealth to find in-network doctors.
Preventive services, or your routine health care, including screenings, check-ups, and patient counseling, to prevent or discover illness, disease, or other health problems. These are typically procedures covered by insurance to encourage wellness and overall better health.
HSA (Health Savings Account)
HSAs are personal health savings accounts that allow you to contribute, withdraw and save money to use for qualified medical expenses tax-free.
Price Transparency & Comparison
At MotivHealth, we often talk about the concept of price transparency or price comparison. Price transparency simply means knowing the cost of care and being able to compare the prices of healthcare services before you go. Our Personal Health Assistance can help guide you through this!
PHA (Personal Health Assistant)
Personal Health Assistants (or PHAs) are your personal team of advocates in the healthcare system available to you 24/7. They’re there to help YOU get the care you need when you need it.
Our PHAs spend lots of time helping members utilize Prompt Pay. Paying before or on the day of service, or “paying promptly,” is a unique way to cut the cost of your service. Many larger medical expenses qualify for large cost reductions when you pay in full before a given date.
Our Prescription Assistance Team is here to provide a free cost assessment of your medications to make sure you are paying the lowest-cost option available. Learn more.
When engaging with us, you’ll often use your member portal. The Member Portal is your personal MotivHealth profile that allows you to track your HSA funds and investments, your deductible status, how much you’ve earned with our Steps Program, and more.
Our Search Portal is essentially a price transparency tool. This is where members search for care, compare prices, find an in-network provider, and schedule appointments.
For a complete glossary of health coverage and medical terms, please visit: