Understanding Your Health Plan

Health insurance – what is it and why do we need it? To put it plainly, health insurance is a plan, or policy, that covers a percentage of your healthcare, such as doctor’s visits, prescription costs, and hospital bills. Its purpose is to help offset medical costs, whether they’re planned or happen unexpectedly. Health insurance can also keep us feeling great with preventive care and wellness programs, so you can focus on living life to the fullest!

Health Care Terminology

If the terminology used in health care seems a bit much, don’t worry, you’re not alone. There are so many different terms and acronyms used, it can be quite confusing. Below are some popular healthcare terms:

• Affordable Care Act (ACA)

The health insurance reform law aimed at expanding health insurance coverage for people living in the United States. ACA is also commonly referred to as “Obamacare.”

• Benefit

A service, drug, or item that your health insurance plan covers. Benefits may include office visits, lab tests, and procedures.

• Claim

A request to your health insurance plan by you or your provider to pay for the covered services you received.

• Deductible

The annual amount you pay for covered health care services before your insurance plan starts to pay. For example, with a $2,000 deductible, you pay the first $2,000 of covered services yourself.

• Health Maintenance Organization (HMO)

A network of contracted physicians, hospitals, and other health care professionals that provides and coordinates an individual’s health care services. Due to the contracted rates, HMOs typically offer lower monthly rates and out-of-pocket costs.

• Medicare

A federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with end-stage renal disease.

• In Network

The facilities, providers, and suppliers your health insurance plan has contracted with to provide health care services.

• Open Enrollment Period

The time when you can choose to enroll in a health plan or re-enroll in a health plan you are already in. You can usually do this without waiting periods or proof of insurance. If you are eligible for Medicare, the open enrollment period is the time of year you can enroll or make changes to your Medicare coverage.

• Out-of-Network

The health care providers (facilities, doctors, specialists, and suppliers) that are not contracted with your health insurer or plan to provide health care services.

• Primary Care Provider (PCP)

Your PCP, usually a provider specializing in Family Medicine, Internal Medicine, or Pediatrics, provides general acute, chronic, and preventive care services. They also

coordinate other health care services you may need and refer you to a specialist(s) when necessary.

• Urgent Care

Provides outpatient care for minor injuries or emergencies such as cuts, fractures, minor burns, flu, cold symptoms, and more.

Member Services

At Florida Health Care Plans, Member Services is here to make your life easier. Whether you’re an expert when it comes to health care or still learning, our Member Services department has you covered. Want to find a PCP? We can help. Need assistance understanding your Florida Health Care plan? We can help. Want to find an FHCP Pharmacy? We can help.

Low-Cost, High-Quality Health Care Plans

FHCP offers comprehensive health insurance solutions at affordable rates. Whether you’re looking for individual health insurance, a Medicare plan, group health insurance for your employees, or want to look over our optional benefits, we’re here for you! Our friendly and knowledgeable staff is ready to answer your questions and help you understand your health insuranceoptions.