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Summary

In this video, we'll simplify your health insurance benefits. Whether you're an insurance pro or new to it, understanding your policy is crucial. First, there's the premium, a shared cost through payroll deductions. The deductible is the amount you pay before insurance covers claims. Co-pays are fixed costs for services, and coinsurance splits expenses. An out-of-pocket maximum is the total you'll pay for claims in a year. Premiums reflect coverage: higher premiums mean lower deductibles and out-of-pocket maximums. Lower premiums mean higher deductibles and out-of-pocket maximums. Real-life examples show how insurance cuts healthcare costs.

Transcript

Hey there, new hire. Welcome aboard. Very happy you decided to join the Health Carousel family. And today I wanted to talk about your health insurance benefits.

Like many things in life, your health insurance can often be confusing and complicated.

Rather, if you've had insurance before or you're new to insurance, understanding your policy is important to both your health and your wallet.

Let's get started.

Let me help you understand what you're paying for.

First, we have the premium.

This is the cost of having insurance.

Health Carousel pays a portion and you as the employee pay a portion through payroll deductions.

A fixed amount comes out regardless of how much or little you use of your insurance.

Next, we have the deductible.

This is the amount that you must pay towards your medical claims before your insurance plan starts paying for your claims. And this amount varies depending on what type of plan you choose.

Next, we have a co-pay.

This is the fixed amount that you pay for certain covered services, like a visit to your primary care physician, a specialist, urgent care, or a trip to the ER (emergency room).

Typically, a primary care physician co-pay will be the lowest, and the ER visit will be the highest amount.

Then we have coinsurance, and this is a fixed percentage of what your insurance will pay  versus what you will pay on claims once you meet your deductible.

And finally, we have an out of pocket maximum, or an OOPM.

The out of pocket maximum is the total amount that you will pay on claims throughout the year. This is a combination of your deductible, your co-pays, and your co-insurance.

Once you've reached your out of pocket maximum, the rest of your claims are covered for the calendar year. Any amount paid towards your deductible and out of pocket maximum reset every year.

How does it all work?

Premiums typically reflect the amount of coverage. The higher the premium, the lower the deductible and the out of pocket maximum. So you pay more out of your paycheck, but less should you have any medical claims. This is preferred by those that budget for upcoming medical procedures.

Now, on the other hand, the lower the premium, the higher the deductible and the out of pocket maximum. So you pay less out of your paycheck, but more on medical claims. This is typically preferred by those do not anticipate many medical claims or expenses.

Let's apply this knowledge to the real world.

The average cost of a doctor's visit is around two hundred dollars without health insurance.

With health insurance, it can be between twenty to thirty dollars, or even free if it's preventative care.

This just goes to show the importance of health insurance, how it can benefit not only your health but your wallet.

It looks like the average cost of an appendectomy without insurance is about thirty three thousand dollars.

But with insurance, you would only be responsible for up to your out of pocket maximum.

And that's a wrap on Health Benefits 101. Thanks for watching.