Coinsurance - You and your health insurance company have agreed to share the cost of paying for procedures to a certain dollar limit called a Stop-Loss. Once the Stop-Loss is exceeded, your health policy will pick up the bill for covered procedures. (i.e. Jim has a 80/20 % Coinsurance and a $10,000 Stop-Loss. This means that Jim is required to pay 20% or $2000 of $10,000 of procedures in a given calendar year above his deductible. In the above case, Jim pays a $500 deductible and $2000 for his Coinsurance, his health insurance pays $12,500.)

Co-Payment is the amount of money you must pay for services rendered regardless of co-insurance and the deductible. (i.e. Jim goes to the doctor for a physical and is required to pay a co-payment of $15 for the services rendered.)

COBRA (Consolidated Omnibus Budget Reconciliation Act)- Federal program requiring group health plans to offer employees continuation of coverage when employment is terminated. Request more information by e-mail for details, restrictions and size of group requirements. CO-INSURANCE- On plans that pay a percentage of expenses (usually after a deductible has been met), co-insurance refers to the percentage paid by the insurance and the percentage paid by the insured.

DISABILITY INSURANCE - Provides payment to insured when disabled and unable to work. Usually, payments begin after a certain period (elimination period), and will continue to pay for a specific period of time ( to age 65, 10 years, etc) as long as the insured is unable to work. Maximum payments are usually limited to a percentage of the insurd’s prior year earnings and are usually made on a monthly basis.

FORMULARY - A listing of included prescription drugs on a prescription drug insurance plan.Some prescription plans offer different co-pays for generic and brand name drugs, and a third co-pay for drugs that are not on their list of approved drugs. Insurance companies and HMO’s often contracts with a third party to provide this benefit to their members and policyholders

GROUP INSURANCE - Employers with employees are eligible for “Group” insurance. These plans are available regardless of existing medical conditions (they may have one to two year waiting periods for preexisting conditions depending on whether or not prior qualifying insurance exists). Proof of self-employment or business existence usually requires income tax records reflecting income from self employment or business. New business have other requirements

HMO - Health Maintenance Organization - Available to group and individuals, plans offer payment of benefits with co-pays required. These plans usually excel in providing coverage for preventative care and pregnancy. Members must use doctors and other providers who are contracted with the HMO, otherwise, there is no coverage.

INDIVIDUAL INSURANCE - Plans obtained by individuals and families who will pay premiums without any employer involvement. These plans require full medical “underwriting”, applicants answering questions about prior medical history ; sometimes medical exams are required. The insurance company or HMO may decline to issue if the preexisting medical conditions are not acceptable risks.