Insurance Definitions – Glossaries 

Insurance #definitions & glossary

• The best place to look for Insurance definitions & glossary  is in an actual EOC – Evidence of Coverage  (specimen – Platinum) – Policy. Be sure to check your ACTUAL EOC for your specific question.
• CA Dept of Insurance Glossary
• CMS – Medicare
  • CA Health Care Advocates Glossary
• Health Net 6  page glossary
  •  Español (Spanish)
  •  (Chinese)
  • Navajo
• aw.com
• CA Court Site Glossary
• Medi-Cal – Helpful words to know
  •  Glossary
• Texas DOI Glossary
• Glossary of Employee Benefit Terms See the Benefits.com
• FAQs / Ask Us a Question

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Deductible #Carryover.

Many plans used to offer a provision called a deductible carryover.  However, Last quarter deductible carry over has gone by way of the dinosaurs – carriers no longer offer this.

This provision allows you to carry over to the next year any unmet portion of the deductible that you, or your family, run up in October, November and December. For example, assume you had no medical claims in the first part of the year. In November, you run up $350 worth of claims. If your deductible was $500, you would start the next year with $350 of your $500 deductible already meet.  Example

However, there is no deductible credit for PPO plans  since all plans are set up for Calendar Year and a renewal won’t effect this nor  a carrier change in the middle of the year since deductible credit for the yearly medical deductible is given by the new carrier (client has to submit EOBs)  ^{9.11.2015 email from Heide} Definition – Investopedia LISA Broker Wholesaler – How and what you need to do to get credit when moving from one insurance company to the other.

Benefit Period

The length of time we will cover benefits for Covered Services. For Calendar Year plans, the Benefit Period starts on January 1st and ends on December 31st. For Plan Year plans, the Benefit Period starts on your Group’s effective or renewal date and lasts for 12 months. (See your Group for details.) The “Schedule of Benefits” shows if your Plan’s Benefit Period is a Calendar Year or a Plan Year. If your coverage ends before the end of the year, then your Benefit Period also ends.  ^EOC   

Crediting Prior Employer Group Plan Coverage

If you were covered by the Group’s prior carrier / plan immediately before the Group signs up with us, with no break in coverage, then you will get credit for any accrued Deductible, if applicable and approved by us, under that other plan. This does not apply to people who were not covered by the prior carrier or plan on the day before the Group’s coverage with us began, or to people who join the Group later. If your Group moves from one of our plans to another (for example, changes its coverage from HMO to PPO), and you were covered by the other product immediately before enrolling in this product with no break in coverage, then you may get credit for any accrued Deductible, if applicable and approved by us. If your Group offers more than one of our products, and you change from one product to another with no break in coverage, you will get credit for any accrued Deductible, if applicable. This Section Does Not Apply To You If:

· Your Group moves to this Plan at the beginning of a Benefit Period; · You change from one of our individual policies to a group plan; · You change employers; or · You are a new Member of the Group who joins the Group after the Group’s initial enrollment with us.

• HSA Insurance.com
  
• Kaiser Group Explanation

What’s this about #embedded & aggregate deductibles?

Individual vs Family Deductibles?

Under family coverage, an embedded deductible is the individual deductible for each covered person, embedded in the family deductible. While it might not sound like a good thing to have two deductibles, it actually works to provide better coverage for individual members because once each family member meets his or her embedded deductible, health insurance begins paying for covered services, regardless of whether the larger family deductible is met.

Contrast this to a non-embedded deductible, also referred to as an aggregate deductible. Under an aggregate deductible, the total family deductible must be paid out-of-pocket before health insurance starts paying for the health care services incurred by any family member. While family coverage with an aggregate deductible may have a lower monthly premium, coverage won’t kick in until the total family deductible is met. In contrast, family health plans with an embedded deductible may help ensure that there is coverage for individual family members once they meet their embedded deductible, regardless of whether the family deductible is met. Unfortunately, the Summary of Benefits and Coverage won’t necessarily tell you if the deductible is embedded or not; you may have to call the plan to learn how the deductible will be applied for your coverage.   Learn More⇒ Center on Health Insurance Reforms   AB 1305

If two or more on a policy it’s the Family Deductible NOT individual, with a family max?

See excerpt of Blue Cross Bronze HSA Page 55 on Family or Individual Deductible

NEW for 2016!!!  Embedded – HSA plans had an aggregate deductible where one person could meet the entire family deductible.   Now a family member will not be charge more than the individual deductible and be able to receive benefits sooner.  ^{BC RSM Email 9.29.2015    SHRM.org   AB 1305 2015 Bonta}

2017 NEW Laws & Regulations effective 1.1.2017  AB 1305, 339 & 1954  SB 999 – Deductible & OOP Maximums FAQ’s

What is the Maximum that can be contributed to an HSA – Health Savings Account?