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Gateway Health is a health insurance company that provides health, dental, vision insurance to employers. Health insurance covers you when you need preventive care, you are sick, or injured. It is there when you need it. Understand your health plan so you are familiar when you need to use it!

Insurance Terms Every Employee Should Know

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  • Premium: This is the amount you pay each month for your insurance. If your insurance is employer-based, your premium is usually deducted from your paycheck.
  • Co-Pay: A fee paid at the time of service.
  • Deductible: This is the amount you must pay each year for healthcare services before insurance begins paying. For example, if your deductible is $1000, you must pay for the first $1000 of your medical services before your insurance will begin covering the costs. Deductibles vary widely depending on benefits.
  • Out-of-Pocket Maximum: This is the most you will pay for medical expenses in a given year. For example, if your maximum out-of-pocket is $7500, all covered charges after that should be paid by insurance at 100 percent. These vary by plan.
  • Co-Insurance: This is the portion of medical expenses for which you are responsible after you have met your deductible. For example if your co-insurance is 20 percent, then insurance will pay 80 percent of covered expenses after you have met your deductible and you will be responsible for the remaining 20 percent.
  • In-Network: This is the list of doctors, facilities and providers approved by your insurance company. Your insurance company has negotiated discounts with this group of medical professionals, so charges in- network should always be lower than those out-of-network.
  • Out-of-Network: Those medical professionals not on your insurance company’s approved list are out-of-network and will charge higher fees.
  • High Deductible Health Plan (HDHP): HDHPs are plans that offer lower premiums with higher deductibles. In many cases, employees are required to pay a higher rate for each medical service rendered until they reach a deductible set by the employer. After the deductible is met, the plan pays a designated percentage of covered charges. These plans often are linked to health savings accounts (HSAs).
  • Preferred Provider Organization (PPO): PPOs offer discounts when you use in-network doctors, providers and facilities, but they do not bar you from seeing out-of-network medical professionals. However, fees for out- of-network services will be higher.
  • Qualifying Events Include: (You have 30 days from the date of the event to make changes)
    - Change in Legal Marital Status – Marriage or Divorce
    - Having a baby or Adopting a child
    - Change in Employment Status
    - Loss of Health Insurance Coverage
    - Child turning 26 – Covered to the end of the month they turn 26

Pharmacy Links:

Healthgram Link for claims, deductible, benefits:

Preventive Services: