Health Insurance 101

Document created by humanaadmin3 Moderator on Aug 1, 2018
Version 1Show Document
  • View in full screen mode

Basic Insurance Terms

Premium: The amount that must be paid for your health insurance or plan. You usually pay it monthly.


Deductible: The amount you – either by yourself or in combination with other covered family members – pay for covered in-network services each year before the plan pays for specified services. Some plans have a separate in-network and out-of-network deductible.


Coinsurance: After you pay any plan deductibles, you may still be responsible for a percentage of that covered services for services you received. This is called coinsurance. For instance, if your health plan pays 70% of covered services, your coinsurance payment is the remaining 30%.


Copayment: The flat amount you pay to a healthcare provider or pharmacy at the time of service. Copayments vary depending on your plan and the services you receive.


Maximum Medical Out-Of-Pocket Cost: This is the most money you will be required to pay within a year for deductibles, coinsurance, and copayments. Regular premiums are not included in calculations of your maximum medical out-of-pocket expenses.


Network and In-Network Provider: Humana has negotiated lower rates from specific doctors, hospitals, and other providers, so these providers are part of Humana's networks and are referred to as in-network providers. They are also called participating providers.


Staying in Your Plan's Humana Network to Save Costs

It's nice to know that if you need medical attention, you can get it, and that your Humana health insurance plan is going to help make it more affordable. But there's one thing that you have to remember if you want to cut out-of-pocket costs as much as possible: Make sure your doctor or hospital is in your plan's Humana network.


When you go to doctors, dentists, or pharmacies in your plan’s Humana network, you pay less for covered expenses than if you visited doctors, dentists, or pharmacies outside your plan’s Humana network. When you go out of your plan’s network, Humana covers less of the cost, so your out-of pocket costs may be higher. So, staying in your plan’s Humana network helps you manage your healthcare costs and save money.


What will happen if the doctor or hospital is not part of your plan’s Humana network? That’s a really good question. It could cost you more money. Some doctors and hospitals might make you aware of the fact that they are not in your plan’s Humana network, and that their service could cost you more money out-of-pocket compared to using a doctor or hospital in your plan’s Humana network.


However, they are not required to tell you before you are seen by a medical professional. Sometimes, the services you get from providers not in your network may not be covered – except in an emergency. That means you could be responsible for the bill for a medical service that is more expensive for you than if you had used a doctor or hospital in your plan’s Humana network.


So remember to keep your out-of-pocket expenses to a minimum by making sure that your medical service providers are officially listed as a recognized doctor or hospital in your plan’s Humana network. It could save you a considerable amount of money. And the best way to make sure is to check your plan’s provider directory.


Go to for a list of Humana-recognized doctors and hospitals.


What does “in your network” mean? Doctors and hospitals in your plan's Humana network will cost you less money out of pocket. Doctors and hospitals out of your network will often cost you more money out of pocket for the same service.