To help you determine the best insurance provider for you and your family when shopping for plans through the Health Insurance Marketplace, we have provided key definitions, Frequently Asked Questions and Insurance Provider information so you can make an informed decision on the coverage that is right for you.
For more information about insurance enrollment and insurances we accept, please call our Patient Access/ Financial Counseling Department at 928-336-7011.
For information on the financial services available to you, please visit our Financial Services Department page or call 928-336-7030.
Annual Out-of-Pocket Maximum: Is the maximum amount of money a member will pay before a network begins covering all medical expenses. Before reaching the out-of-pocket maximum, a member pays for part of the medical care, including copays and coinsurance.
Co-Insurance: The portion or percent of the insurance claim the member pays after the deductible and co-payment.
Copayment: an amount fixed fee a member may be required to pay as their share of cost for a medical service or supply, including a doctor’s visit or prescription drug.
Deductible: The minimum amount of money a member must pay before an insurance company will pay a claim.
HMO vs. PPO
A Health Maintenance Organization (HMO) is a network of doctors and hospitals you are allowed to see. This is also referred to as in-network. With a Preferred Provider Organization (PPO), you can see any doctor you choose. If you belong to an HMO and choose to see a doctor out-of-network you may pay a higher co-payment. All current Marketplace Exchange programs are PPOs. It is advised that you check that your current physician falls within that PPO before selecting a health insurance plan.
Member: If you have a health insurance provider, you are a member of that group.
Network: The facilities, providers and suppliers your health insurance plan has contracted with to provide health care services.
Out-of-Network: A provider that hasn’t contracted within the network is called an “out-of-network provider.”
Premium: A member’s periodic payment to an insurance company or healthcare plan for health or prescription drug coverage.
Provider: Another term for a facility or caregiver (physician or nurse practitioner) a patient seeks medical guidance or treatment from.