FREQUENTLY ASKED QUESTIONS

What is a deductible?
A deductible is your up-front financial responsibility before the insurance starts paying. Some services are deductible waved, so check your plan summary for details.
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What is co-insurance?
Co-insurance is the percentage split between you and the insurance company after you meet your deductible. You may be responsible for 10%, 20%, 30%, 40%, or even 50% of the bill after meeting the deductible, but only up to the maximum out-of-pocket.

What does "maximum out-of-pocket" mean?
Your maximum out-of-pocket is the most you will pay for covered services in a calendar year.

What is a co-pay?
A co-pay is a set amount that you pay for service. Often insurance plans will have co-pays for a doctor’s office visit, out-patient mental health visit, etc.

What is a premium?
A premium is the amount you pay to the insurance carrier for your health insurance plan.

What is a PPO?
PPO stands for “Preferred Provider Organization”. With a PPO, you can see in-network medical professionals, or out-of-network medical professionals. However, your benefits are much richer when using in-network medical professionals.

What is an HMO?
HMO stands for “Health Maintenance Organization”. You must choose a primary care physician who manages your care and refers you to in-network specialists, if necessary.

What is an EPO?
EPO stands for “Exclusive Provider Network”. You may see any contracted physicians, but the plan does not cover non-contracted medical professionals or facilities.

What is an EOB?
EOB stands for “Explanation of Benefits”. It is provided by the insurance company to show you several things: how services billed were covered by your insurance, how much the medical provider billed your insurance company, how much the negotiated rates lowered the bill, how much was applied to your deductible, and what your financial responsibility is.

What is an SBC?
SBC stands for “Summary of Benefits and Coverage”. It outlines how your coverage works. A required form since The Affordable Care Act, it is designed to help you understand and compare the coverage options from each carrier in a standardized format.

What is a formulary?
A formulary is a list of the medications that your insurance covers. It’s important to check the formulary prior to purchasing your plan to ensure you have the proper coverage for your medications.

What is an HSA?
HSA stands for “Health Savings Account”. You must have an HSA-compatible health insurance plan in order to contribute funds to a health savings account. A health savings account allows you to use pre-tax dollars to help pay for qualified medical and dental expenses. Go to www.irs.gov for complete rules and guidelines.

What is Covered CA?
Covered CA is the state exchange for California where you can purchase health insurance, receive tax credit and subsidy, if eligible.

How does Access Health get paid?
Insurance agents are paid by the carriers for the policies that they sell. We quote the same pricing that you will get directly from the carriers.

Do you have a question that’s not answered above? Call us at (760) 727-9000 or fill out our Contact Us form and we will answer your questions promptly.