Understanding benefits in your new health insurance policy can be frustrating. You will find the particulars about your plan in a document you receive with your policy, the Summary of Benefits or Benefits Schedule. Familiarizing yourself with the terminology will help you to make the most of your plan.

Deductible

The deductible is the amount you must pay, per person, before the policy begins to pay your medical bills. It is usually an annual deductible. There may be certain services that don't require you to meet a deductible first such as doctor visits.

Copayment

Many plans have a copayment for doctor visits or prescriptions. This is the amount you pay to the doctor at the time of each visit. The prescription deductible is paid per prescription and can vary depending on whether you get a generic or brand name drug.

Coinsurance

Coinsurance is the percentage that the insurance company pays of covered expenses. It is common for an insurance company to pay 80% of expenses with the remaining 20% being the patient's responsibility. If you have a PPO or HMO plan then they may pay covered expenses at 100%.

Lifetime Maximum

You policy may or may not have this provision. A lifetime maximum is a cap on the amount an insurer will pay over an individual's lifetime. There may also be a family lifetime maximum.

Exclusions

These are the expenses that are not covered. There is usually a list of specific exclusions in the plan document. Review this carefully so that you are not caught by surprise when filing a claim.

Pre-existing Conditions

A pre-existing condition is one which the insured person was treated for prior to the date the policy took effect. Usually the insurer will look at the 12 months prior to the policy to find out if the condition is pre-existing. The insurer will ask for information from you on the claim form and request information from your doctor. If they determine that the condition is pre-existing then there may be no benefits or limited benefits for that condition for up to a year.

Coordination of Benefits

This can an especially confusing part of filing an insurance claim. If you have two group policies they combine their benefits so that the amount paid out is not more than the medical expenses. For instance if you are covered under your husband's employer and also under your own employer your insurance would be primary. Once your insurance has paid the claim goes to his insurance company so they can pay the balance of the claim.

If you have trouble understanding benefits in your health insurance policy it is best to have those answered before you receive treatment. There is usually a toll free number on your insurance card and in your plan document.