Health Insurance Partners
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Our Health Insurance Agents
 Terry Jones (Glencoe) |
 Mary Adelmann (Glencoe) |
 Ted Breckheimer (Shorewood) |
Insurance Coverage Options & Terms
COBRA is Federal legislation that lets you continue to purchase health insurance for up to 18 months if you lose your job from a company with 20 or more employees or your coverage is otherwise terminated.
Coinsurance is a form of medical cost sharing in a health insurance plan that requires an insured person to pay a stated percentage of medical expenses after the amount of the deductible is paid.
Copayment is a form of medical cost sharing in a health insurance plan that requires the insured to pay a fixed dollar amount when a medical service is received.
Deductible is the amount an individual must pay for health care expenses before insurance covers the costs.
Dental Insurance is insurance that provides coverage for services relating to the care and treatment of your teeth and gums.
Group Insurance is coverage through an employer or other entity that covers all individuals in the group. Networks provide services at a lower cost to the insurance companies with which they have contracts.
Group Health Insurance is a single policy which covers the medical expenses of a group of people, rather than an individual. All eligible people can be covered by a group policy, regardless of age or physical condition. The premium for group insurance is calculated based on the characteristics of the group as a whole, such as average age and degree of occupational hazard.
Individual Health Insurance is coverage on an individual basis. The premium is usually higher than a group policy, but an individual policy may be needed if you do not qualify for a group plan. The policy covers the medical expenses of only one person or family and is purchased directly from an insurance company. When you apply for individual insurance, you are evaluated in terms of how much risk you present assessed by a series of medical questions and/or a physical exam. Your risk potential determines whether you qualify, and how much your insurance policy will cost.
Long-Term Care Policy are policies that cover services for a specified period of time. Long-term care policies and their prices vary significantly. Covered services often include nursing care, home health care services, and custodial care.
Medicare is a federal program that provides health insurance to retired individuals regardless of their medical condition. Medicare coverage consists of two parts--Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). Medicare Part D is a federal program which subsidizes the costs of prescription drugs for Medicare beneficiaries in the United States.
Medigap Insurance is a Medicare Supplement. Because Medicare won't cover all your health-care costs during retirement, you may wish to consider purchasing a supplemental medical insurance policy called Medigap.
Network is group of doctors, hospitals and other health care providers contracted to provide services to insurance companies customers for less than their usual fees. Provider networks can cover a large geographic market or a wide range of health care services. Insured individuals typically pay less for using a network provider.
Out-of-Network refers to physicians, hospitals or other health care providers who are considered nonparticipants in an insurance plan (typically an HMO or PPO). Expenses incurred from services provided by out-of-network health professionals may not be covered, or only partially covered by an individual's insurance company.
Out-Of-Pocket Maximum is a predetermined limited amount of money that an individual must pay out of their own savings, before an insurance company or (self-insured employer) will pay 100 percent for an individual's health care expenses.
Pre-existing Conditions are medical conditions that are excluded from coverage by an insurance company, because the condition is believed to have existed prior to the individual obtaining a policy from the particular insurance company.
Short-Term Disability provides coverage due to an injury or illness that keeps you from working for a short time. The definition of short-term disability differs among insurance companies and employers. Short-term disability insurance coverage is designed to protect an individual's full or partial wages during a time of injury or illness that prohibits the individual from working.
Short-Term Medical is temporary coverage for an individual for a short period of time, usually from 30 days to six months.
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