Major Types of Health Insurance
- Medical Expense Insurance: Pays for hospital and doctor bills.
- Disability Income Insurance: Pays if you can't work due to injury or illness.
- Accidental Death & Dismemberment: Pays if you die or lose limbs/sight due to an accident.
Key Terms
- Deductible: What you pay out-of-pocket before insurance starts paying.
- Coinsurance: You share a % of the cost after deductible (e.g., 80/20).
- Copayment: Flat fee for a service (e.g., $25 doctor visit).
- Out-of-pocket Max: Max you'll pay in a year before insurance covers 100%.
- Pre-existing Condition: Health issue you had before coverage started.
Texas-Specific Notes
- Policies must clearly state coverage and exclusions.
- Must cover newborns and adopted children.
- Texas has a state-run high-risk pool for people denied regular insurance.
Flashcards
What is a deductible?
The amount you pay before insurance starts paying.
What does coinsurance mean?
The % you pay after deductible (e.g., 20%).
What is a copayment?
Flat amount you pay for services.
Who must be covered under TX group plans?
Newborns and adopted children.
What’s an out-of-pocket max?
The most you'll pay before insurance pays 100%.