At Yuma Regional Medical Center, we understand that this can be a confusing time in healthcare. 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.
Still have questions about Marketplace?
Contact Yuma Regional Outpatient Clinics at 928.336.7095.
Annual Maximum: This is a defined dollar amount a health insurance provider will pay toward a member’s covered expenses within a calendar year.
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.
Health Insurance Companies providing services within Yuma County:
Blue Cross Blue Shield
Health Insurance with a provider network outside of Yuma County:
Blue Cross Blue Shield
*Expected provider network within Yuma County beginning in 2015:
United Health Plan