Insurance Terminology You Need To Know: Part IV

Welcome to part four of our series in insurance terminology you should definitely know — especially if you’re a new buyer of any kind of insurance. It never hurts to brush up when you’re rusty. Today we will look at a few terms like HMO, HRA, and HSA that are abbreviated to become more confusing than they have to be. 

What is an HMO?

HMO stands for “Health Maintenance Organization.” When you see HMO on your plan, it means you can only go through the specific HMO providers outlined by that plan. Usually, this means choosing one doctor in the network to be your primary care physician. Should you need to see a specialized doctor, your primary care physician will provide you with the right referral.

What is an HRA?

HRA stands for “Health Reimbursement Account.” An HRA is usually a benefit shared through an employer, and it allows you to deposit money from your paycheck to funnel toward healthcare expenses as needed — but this is purely a savings account with no tax benefits. It’s good for people who have trouble hanging onto their money for more than a day.

What is an HSA?

HSA stands for “Health Savings Account.” Another benefit normally shared through an employer, but an HSA normally allows the user to avoid federal taxes on anything deposited into the account. Funds deposited into an HSA do not need to be spent in a given timeframe, which makes them a great way to complement insurance. 

What is a PPO?

PPO stands for “preferred provider organization.” A PPO is similar to an HMO, except they usually cost more through higher premiums — and also provide limited coverage for when healthcare providers are used outside of the network. These plans are great for people who like to travel or move often for work, because they still offer some coverage in case you’re not where you normally are.

What Is Credit Insurance?

One of the scariest decisions an adult will ever make is putting a mortgage on their first home. These are the most detailed business arrangements that most of us will ever sign, and when you’re unaccustomed to reading contracts — especially contracts with an excessive amount of jargon contained within — it can be a stressful endeavor. Whether or not it’s worth it depends a lot on the contract signed, so it’s better to be safe than sorry. Credit insurance might prevent even more stress.

But what is credit insurance and when is it applicable? Here we go! First things first: many loans you might take out can come with a credit insurance stipulation already attached, mortgages included. When a person’s financial situation changes or the payments become too much of a burden, the credit insurance kicks in. 

One thing you should know before signing any agreement is that it’s actually illegal for a creditor to include this type of insurance without specifically telling you. This is according to the Federal Trade Commission (or FTC). Keep that in mind if you ever find that there were a few extra clauses slipped into your agreement — also keep in mind that this is why a mortgage or other big loan requires that you read the contract. This isn’t one of those that you can just skip over.

What types of credit insurance are there? Credit life insurance, credit disability insurance, involuntary unemployment insurance, and credit property insurance. 

Credit life insurance is what you buy when you’re worried that you might pass away before you get the opportunity to completely pay off your loan. This is a big concern for homeowners who will likely be paying off a mortgage for over a decade with a fixed plan. You won’t be able to leave that home to your beneficiaries without their willingness to take over the money owed on the loan, so credit life insurance is a way to offset this possibility.

Credit disability insurance kicks in when you become injured or disabled and can no longer make payments on your loan because you can no longer work. Involuntary unemployment is exactly what it sounds like — it kicks in when you are fired or laid off from your job, as long as the reason for your termination was not your fault.

Credit property insurance is similar to homeowners or renters insurance in that it protects against many different types of loss. That means if an arsonist sets fire to your house and you lose everything, the credit property insurance will kick in to help pay what remains of the loan. Just keep in mind you’ll need actual homeowners insurance if you want the property rebuilt, though.

When shopping around for credit insurance, there are plenty of questions you might ask to make the process easier — not the least of which is “how much does the premium cost?” If you’re not in the mood to shop around, you can always ask the creditor directly. Chances are they will have plenty of options for you to choose form, and can provide help choosing the best type of coverage for you.

Insurance Terminology You Need To Know: Part III

This is part three of our series on insurance terminology. We decided to define many of the words associated with insurance coverage to ensure that those seeking a working knowledge would be able to obtain it. Not sure what a particular term means? You’ll find it here sooner or later, and they aren’t that difficult to sift through since they’re in alphabetical order. Here are a few more terms.

What is creditable coverage?

Creditable coverage usually refers to the person whose coverage comes from another source, including Medicare or Medicaid, which are two of the most common creditable coverage plans. Others include group health plans, military healthcare plans, Indian Health Service (and other tribal programs), risk pools, the Federal Employees Health Benefits Program, a Peace Corps Act health plan, etc.

What is a dependent?

A dependent is basically someone who relies on another for support. For example, a parent might claim one or more dependents (his or her children) when filing tax forms. Dependents usually provide a taxpayer with credits or other benefits. There are other examples of dependents, such as someone who is disabled.

What is an emergency medical condition?

On a healthcare plan, you’ll want to make sure you understand anything outlined under the emergency medical condition clause. These are conditions that put your health at risk, but sometimes specific conditions are outlined in a particular plan while others are left out. 

What is an FSA?

A flexible spending account (or FSA) is usually provided through an employer. These plans allow a person to set aside funds for certain contingencies. The money is considered “pre-tax” which means you won’t have to pay taxes on the FSA funds until the money is removed from the account. These funds can be used for specific reasons, like paying copays, hospital fees, physical rehabilitation costs, or dental expenses. Vaccines are also included.

What Does Workers Comp Actually Cover?

Workers comp is a type of liability insurance that protects two parties: both the employer and the employee. Both parties typically pay into a pool of money with each paycheck. When an employee is injured on the job, the employer can dot the “I”s and cross the “T”s to make sure that the employee can use that aforementioned pool of money for healthcare resulting from the injury, regardless of whether or not the employee has health insurance. It also helps protect employers by reducing the chance that an employee will file a personal injury lawsuit.

Workers comp covers accidental workplace injuries. An employee may be allowed to dip into the pool of money to cover healthcare costs, costs associated with lost wages or earning potential, costs of physical therapy, or funeral expenses if the worst should happen. Believe it or not, workers comp might even pay more if an employee is scarred because of the injury! Employees probably won’t need a slip and fall attorney for a simple accident, and that’s thanks to workers comp.

But there are exceptions to every rule, and workers comp is no different. What isn’t covered? It depends on where you live and what happened. For your state rules and regulations, check with your employer (or a lawyer if you don’t trust your employer). 

Here’s what we can say for sure. If the accident was caused by an employee — and keep in mind there’s a very stark legal difference between cause and effect — then the employee might not be covered. One obvious example involves fighting. If an employee tries to punch another employee or customer in the face, misses, and is whacked in retaliation, then workers comp absolutely will not cover his broken nose. He started the fight, after all. On the other hand, if the employee is hurt in a fight they didn’t start, then workers comp would absolutely cover medical expenses. 

The first thing an employer will likely do after an employee is injured in an accident is ask the employee to submit to a drug test. Don’t want to take the drug test? That’s legally fine, but you’re sure to lose your job. Take the drug test and it comes back positive? Bye Felicia. You’re sure to lose your job. Keep in mind that some drug tests will come back positive even if you consumed alcohol a full 24 hours prior. So even though the tests aren’t always fool-proof, an employee could still be screwed over — and need to pay for their own medical expenses after an accident. 

If you are an employee and were hurt while working, then you should have already contacted your direct supervisor. Failure to do so might make it more difficult for you to make a workers comp claim later, especially if there’s no video footage of the accident or no one around to corroborate your story. When reporting the injury, provide a full accounting — including your written story, if possible — and make it as detailed as you can.

Insurance Terminology You Need To Know: Part II

Welcome to part two of our series on insurance terminology. Some of these definitions are common knowledge, while others might be more obscure. If you’re a new buyer, then you’ll want to know what you’re getting yourself into before you make any final decisions. That’s where we come in. Here are a few more terms to know before exercising your purchasing power!

What is an allowed amount?

The allowed amount is the highest dollar amount that an insurance company will ever pay. Here’s an example of the world’s worst healthcare plan: 75% coinsurance, $9,900 deductible, with a $25 allowed amount. This scam means the highest amount the company would pay is $25, and only after you’ve paid the $9,900 deductible. Plus, you’ll have paid another $75 to obtain their $25 via coinsurance. Whoops! Buyer beware.

What is a condition?

In healthcare, a condition is the illness or disease covered or not covered by insurance. Be wary of insurance contracts that don’t cover common health problems like heart disease or cancer. They might serve for a broken leg, but nothing else. 

What is a copayment? 

Many insurance contracts involve some sort of a copayment when you use a particular service. Let’s say you need to visit the doctor for a health problem you recently noticed. The plan might note that the deductible is irrelevant for this service, but that there is a $25 copay. That means the visit is covered by insurance, and all you’ll have to pay is the $25. Not too shabby.

What is a covered charge?

Covered charges are exactly what they sound like: they’re charges made to the insurance provider for covered services. This is of particular relevance to those who might be traveling, because they’re more likely to need the healthcare services of an out-of-network establishment. Most insurance providers will place a strict limit on the covered charges when venturing out-of-network.

What Is Divorce Insurance?

Divorce insurance is something that many married couples “Google search” for when tying the knot — and no wonder, because 9 out of 10 people will marry by the time they reach age 50 and up to half of those couples will inevitably divorce. But unfortunately divorce insurance doesn’t actually exist. There was a sort of divorce insurance “test” back in 2010, but big shock: it didn’t work out for the insurer. The theory was simple enough. Married couples can experience financial upset during divorce, so why not offer them a backup plan?

Probably the biggest problem with the actual “divorce insurance” concept is that there are already fail-safe measures that can be preemptively taken by couples if they want to protect their financial interests against divorce. But even those measures are scrutinized and stigmatized because marriage is supposed to be a lifetime vow — a commitment. Take the prenup, for example: the legal contract can stipulate what would happen should divorce take place, and is signed before the marriage licenses are obtained.

The difference between a prenup and the doomed divorce insurance was simple enough, though. A prenup is an agreement between two committed partners, while divorce insurance was an agreement between a business and just one of those assumedly committed partners.

But the problems with divorce insurance are equally obvious. Do you think an insurance company willingly pays out a settlement unless forced? Not a chance. When you’re in a car accident between two or more parties, the insurance company literally sends out highly qualified and well paid individuals to make sure the story you provide is the right one. If you were the cause of the accident, don’t expect to get anything that isn’t owed.

But how do you make an agreement that basically says “if you divorce this person, you’ll receive this benefit”? The coverage basically becomes about what would happen under set conditions, just like any other insurance. Your spouse cheated on you and you want a divorce? Great. Your divorce insurance benefit should pay up. But first you need to provide beyond any shadow of a doubt that your spouse actually cheated. Any footage of that event? Hint: you’re probably breaking a half-dozen laws by having footage of that event, much less sharing it.

So you can see why the coverage options were likely doomed from the beginning.

But there’s probably no replacement for a traditional divorce attorney. Looking for one? You can visit website of any local attorney you choose, and most will always offer a free consultation to see if you’re a good match.

An attorney can also help relevant parties come to a marriage settlement, which is typically an agreement made to iron out details of who pays what (think alimony or child support) after marriage. The might also include more immediate concerns like assets, child custody, child visitation rights, etc. It’s always a good idea to know what you want out of a marriage — and what you want out of a divorce.

Check out some of the coverage when divorce insurance was first offered:

Insurance Terminology You Need To Know: Part I

Anyone buying or selling insurance for the first time will quickly realize the extensive amount of jargon associated with the industry. It’s not always self-explanatory, either. Do you know what the repatriation of remains is? What is an FSA? Or an HMO? HRA? …HSA? No matter how fluent you might be with the lingo, sometimes it helps to brush up on the really complicated terms. Here are a few of the most common in the first part of our series on insurance terminology.

What is a benefit period?

This is the exact period of time during which a particular plan will cover a particular person. A benefit period that lasts for three months might begin February 5 and run through October 5. That means the coverage is still good on both of those days — and every day in between. For health insurance plans, the coverage is usually good for one year, but keep your eye on the specific dates. 

What is coinsurance?

Many people who have never purchased an insurance plan might mistakenly assume this is some type of shared insurance between two people. But it’s not. This is shared payment between you and your insurance provider. Coinsurance is usually provided as a percentage of the amount owed. It usually kicks in after the deductible has been paid. 

What is a deductible?
This is probably the most important new term you need to learn! The deductible is the amount you pay for a service (usually healthcare) before an insurer will pay a dime for specific services. Before purchasing a plan, pay close attention. Cheaper plans usually have higher deductibles, which can be terrible if you don’t have much money in your wallet. For example, a $5,000 deductible means that if you are diagnosed with a life-threatening form of cancer, you would have to pay $5,000 before your insurer helps out. And don’t forget — you might still be paying a lot in coinsurance.

How Are Employers Covered By Business Insurance?

Insurance was a scheme devised to help people protect themselves from risky ventures. While we might not think of owning a vehicle as a “risky venture,” tens of thousands of people die in wrecks each year — and that makes it a fair risk for personal injury or financial loss. And there are many different types of insurance ranging from pet insurance to business insurance. There is no greater risk than starting a new business. It’s hard work. Success is not always guaranteed. So why should business owners insure themselves, and what does business insurance cover?

Business insurance usually consists of general protections to guard against natural disaster, property damage, lawsuits, and “shrink” (which is profit loss due to product damage or theft). It comes down to liability. In many cases the business owner is liable — but can buy insurance to offset those liabilities. 

Depending on the type of business insurance, the owner might have legal or financial options if an employee reports discrimination in the workplace. In order to maintain coverage, an owner would likely be asked to exceed state and federal regulations on discrimination by offering extensive training courses and workshops designed to further mitigate the risk of these types of reports by employees. 

Many entrepreneurs will purchase a Business Owner’s Policy (or BOP). These policies combine several different types of coverage, including property protection, general liability, and business income protection. BOPs are popular because they represent a deal — entrepreneurs can save money on one type of coverage by combining it with many other types of coverage. The more protected, the more you stand to save if the worst happens (and the less you spend on the insurance itself).

A BOP will help protect an owner against other claims as well, frivolous or not. Sooner or later, a customer will likely report sustaining an injury in your store. This is an inevitable consequence of running a business. If you need to fight the claim in court, the business coverage will help offset the costs of hiring a lawyer and making a case. The same type of coverage protects against customer claims that you falsely advertised a product or service.

Many business owners will want business income insurance, which will protect against losses sustained due to closure. The reasons for such a closure might include natural disaster, theft, or another kind of unforeseen damage. 

If your business involves greater-than-normal bookkeeping (if you own a law firm, for example), then you will likely want to obtain professional liability insurance to protect against a client who makes the claim that a small clerical error cost him money. The important thing to remember is this: making a mistake is all that is necessary for a costly lawsuit. It doesn’t mean you did something wrong. These suits can still be costly if you don’t have the appropriate insurance.

Workers’ compensation insurance — not to be confused with actual workers compensation — is insurance that guards against losses incurred because an injured employee can’t work (because they’re out on workers comp and cannot be easily replaced!).

Could A Conservative-Dominated Supreme Court Destroy Health Insurance For Millions?

This question has been propelled to the top of the list ever since Trump and McConnell fought to ram through a new Supreme Court nominee weeks ago: Will a 6-3 conservative-led Supreme Court fight to abolish the Affordable Care Act (ACA)? Depending on whether or not you support Obamacare, you might not like the answer. Truth be told, the ACA has been attacked for years, and many GOP government officials have made their distaste for the law very well known.

The moment that Trump made his nomination of Barrett, healthcare stocks began to react volatilely. 

Jefferies health care analyst Brian Tanquilut had warned: “It sounds like the Republicans are really gonna push for a Supreme Court nominee approval before the new administration (and) the fear is that the ACA will be probably repealed. I’m not sure that’s necessarily the case, but obviously that’s the fear that’s been baked into the stocks right now.”

Regardless of the outcome of the election, things were never going to get less uncertain than they are right now. There is a small amount of good news. During Obama’s time in office, the GOP members of the Senate made dozens of votes to repeal and replace Obamacare knowing they didn’t have enough votes to get anything done), but once Trump made it into office, and they might have been able to make waves, they stopped holding votes. In other words, it might all have been for show in order to retain the appeal of their constituents.

Unfortunately, that doesn’t mean a conservative-led Supreme Court won’t do what a conservative-led Senate wasn’t willing to do themselves. But Professor Nicholas Bagley of the University of Michigan Law School acknowledges that the balance of power is shifting so much that no one really knows what will happen.

He said, “If the case gets argued in front of a new Supreme Court with a new justice, the center of gravity and the court will no longer be with Chief Justice Roberts, who has turned away too much stronger challenges to the law. It’ll be with the other conservative justices.” 

Democrats need to start winning over “purple” states like Texas if they want to cement their chances of winning state, local, and federal elections over the long-term — as doing so is the only way to ensure that civil rights and well-liked healthcare programs (like the ACA) stay in place for years to come. Even should Democrats continue winning elections, though, the Supreme Court is still lopsided in favor of conservative voices, which means that the ACA remains in a state of constant peril for years to come.

Texas Senator John Cornyn made his opposition to the ACA clear weeks ago during a press conference at City Hall in Dallas, even though he admitted that he favored coverage based on preexisting conditions. To keep the ACA safe, officials like him need to continue to be kept away from higher office.

A ruling five years ago upheld many core tenets of the ACA:

What Would Happen To Insurance Rates If Obamacare Is Overturned?

The death of Ruth Bader Ginsberg means that new Supreme Court nominee Amy Coney Barrett will likely be seated before Election Day, providing the highest authority in the land with an overwhelmingly conservative 6-3 advantage — providing Republicans with the ability to overturn important historical benchmarks in our country such as marriage equality, Roe v. Wade, or even the Affordable Care Act (ACA).

This is why Democrats are in such an uproar. Majority Leader Mitch McConnell (Republican, Kentucky) said that the GOP has no expectation that the new Supreme Court will overturn the ACA — even though their Republican commander-in-chief is leading the charge to repeal the ACA through legal action expected to reach the Supreme Court. They say they want to “repeal and replace,” which is a talking point they’ve used for years and years — even without putting forth an actual replacement.

Should the ACA be repealed, it is expected that nearly 30 million people will lose their insurance. Also attached to the law are stipulations that all insurers, both public and private, are required to provide insurance to those with preexisting conditions. The repeal of the ACA means that insurers can remove those with preexisting conditions from their plans. Over a million people would also lose their jobs as less money is spent by consumers who would need to decide between insurance and other basic necessities like food or rent.

Insurance companies would also be able to take insurance away from countless 20-somethings, who under the ACA can stay on their parents’ plants until age 26. 

Because of these added benefits, insurance rates went up after the law was implemented — but most of the rate of growth was already expected by industry analysts looking at skyrocketing costs over the years. If the ACA goes away, a temporary lull in rising costs could be expected — but only at the cost of the benefits it provided.