Coverage That Helps You Prepare for the Cost of Care

Healthcare is an important part of protecting your family, your finances, and your future. From routine doctor visits and preventive care to unexpected illness or injury, medical expenses can add up quickly.

Health insurance can help reduce the financial impact of eligible healthcare expenses by sharing certain costs between you and the insurance plan.

At SecureWay Insurance, we help individuals and families understand their health insurance options so they can make informed decisions about the protection that fits their needs.

UNDERSTANDING HEALTH INSURANCE

Health insurance is an agreement between you and an insurance company that provides coverage for certain eligible medical services in exchange for a premium.

Depending on the plan, coverage may help with expenses associated with:

• Doctor visits

• Hospital stays

• Preventive care

• Prescription medications

• Laboratory services

• Diagnostic testing

• Specialist care

• Emergency services

• Outpatient treatment

• Certain medical procedures

The services covered and the amount the plan pays depend on the specific policy and applicable requirements.

WHAT DOES HEALTH INSURANCE HELP PAY FOR?

Routine & Preventive Care

Many health plans provide benefits for eligible preventive services, which can help you stay on top of your health and identify potential concerns early.

These may include certain:

• Wellness visits

• Health screenings

• Immunizations

• Preventive examinations

• Routine medical assessments

Doctor & Specialist Visits

Health insurance may help cover eligible visits to primary-care physicians and specialists.

Depending on the plan, you may pay a copayment, coinsurance, deductible, or other applicable cost.

Hospital & Emergency Care

Unexpected medical situations can result in significant expenses.

Depending on the policy, health insurance may provide benefits for eligible:

• Hospital admissions

• Emergency room services

• Surgical procedures

• Inpatient care

• Outpatient hospital services

Prescription Medication

Many health plans include prescription drug benefits, although the medications covered and your share of the cost can vary.

Some plans use formularies that place medications into different cost tiers.

HEALTH INSURANCE FOR INDIVIDUALS

If you need coverage for yourself rather than through an employer or another group arrangement, individual health insurance may be an option.

When comparing individual plans, consider more than the monthly premium.

Look at:

Monthly Premium
The amount you pay to maintain your coverage.

Deductible
The amount you may have to pay for eligible covered services before the plan begins paying according to its terms.

Copayment
A fixed amount you may pay for certain covered healthcare services.

Coinsurance
Your percentage of the cost of a covered service after applicable requirements are met.

Out-of-Pocket Maximum
The maximum amount you may have to pay toward covered services during a plan year, subject to the plan’s rules.

FAMILY HEALTH INSURANCE

Healthcare needs can differ significantly among family members.

A family health plan may provide coverage for multiple eligible members under one policy or plan arrangement.

When considering family coverage, think about:

• Number of people who need coverage

• Ages of family members

• Regular healthcare needs

• Prescription medications

• Preferred doctors

• Preferred hospitals

• Specialist requirements

• Expected healthcare expenses

• Monthly budget

Choosing a plan based solely on its premium may not provide the best overall value for your family.

HEALTH INSURANCE THROUGH AN EMPLOYER

Many people receive health insurance through an employer-sponsored plan.

Employer-sponsored coverage can differ from individual coverage in terms of premiums, networks, deductibles, benefits, and available options.

If you have access to employer coverage, review the plan carefully before deciding whether additional or alternative coverage is appropriate.

HEALTH INSURANCE NETWORKS

A health insurance network is a group of doctors, hospitals, clinics, pharmacies, and other healthcare providers that have agreements with an insurance plan.

Depending on the plan, using in-network providers may result in lower out-of-pocket costs.

Before selecting coverage, check whether your preferred:

• Doctor

• Hospital

• Specialist

• Pharmacy

• Healthcare facility

is included in the plan’s network.

Provider networks can change, so verify current participation before receiving care.

HMO, PPO & OTHER PLAN TYPES

Health plans can be structured differently.

HMO — Health Maintenance Organization

HMO plans generally emphasize care through a defined provider network and may require coordination through a primary-care provider.

PPO — Preferred Provider Organization

PPO plans generally provide more flexibility when choosing healthcare providers and may allow you to receive out-of-network care at a higher cost.

EPO — Exclusive Provider Organization

EPO plans generally require you to use providers within the plan’s network, except in certain situations such as emergencies.

HDHP — High-Deductible Health Plan

A high-deductible health plan generally has a higher deductible and lower premium than some other plan designs and may be compatible with a Health Savings Account when applicable requirements are met.

Plan features and availability vary.

HOW MUCH DOES HEALTH INSURANCE COST?

There is no single price for health insurance.

The cost of coverage can depend on factors such as:

• Location

• Age

• Number of people covered

• Plan type

• Coverage level

• Deductible

• Provider network

• Household circumstances

• Available subsidies or financial assistance

• Insurance company

Your total healthcare cost can include more than your monthly premium. Deductibles, copayments, coinsurance, and other out-of-pocket expenses should also be considered.

WHAT IS AN OUT-OF-POCKET MAXIMUM?

An out-of-pocket maximum is a limit on what you may have to pay toward covered services during a plan year, subject to the plan’s rules.

Once the applicable limit is reached, the plan generally pays a greater share of covered expenses for the remainder of the applicable period.

Premiums and certain other expenses may not count toward the out-of-pocket maximum.

Always review the specific plan documents to understand what is included.

HEALTH INSURANCE & PRE-EXISTING CONDITIONS

Health insurance rules concerning pre-existing conditions can vary depending on the type of coverage and applicable law.

When evaluating a health plan, review its eligibility requirements, coverage terms, exclusions, and applicable protections rather than assuming that every medical condition or treatment will be covered in the same way.

WHAT HEALTH INSURANCE MAY NOT COVER

Health insurance does not necessarily pay for every medical expense.

Depending on the plan, certain services may be excluded or subject to limitations, including:

• Cosmetic procedures

• Certain experimental treatments

• Services considered not medically necessary

• Certain out-of-network services

• Services exceeding plan limitations

• Certain elective procedures

• Treatments specifically excluded by the plan

Emergency and other special circumstances may be treated differently depending on the plan and applicable law.

CHOOSING THE RIGHT HEALTH PLAN

1. Consider Your Healthcare Needs

Think about how frequently you visit doctors, whether you take regular medications, and whether you expect specialist or hospital care.

2. Check Your Doctors

If keeping your current doctor is important, verify that they participate in the plan’s network.

3. Compare Total Costs

Don’t compare plans based only on monthly premiums. Consider deductibles, copayments, coinsurance, and out-of-pocket maximums.

4. Review Prescription Benefits

If you regularly take medication, check the plan’s drug formulary and applicable cost-sharing.

5. Examine the Network

A plan with a lower premium may not be suitable if your preferred doctors or hospitals are unavailable within its network.

HEALTH INSURANCE FOR DIFFERENT STAGES OF LIFE

Young Adults

A young adult may prioritize affordable premiums, preventive care, prescription benefits, and protection against unexpected medical expenses.

Growing Families

Families may place greater importance on pediatric care, preventive services, prescriptions, and access to appropriate specialists.

Adults Planning for the Future

As healthcare needs change, it may become increasingly important to consider specialist access, prescription coverage, hospital benefits, and overall out-of-pocket exposure.

WHY REVIEW YOUR HEALTH COVERAGE REGULARLY?

Your circumstances can change.

You may:

• Get married

• Have a child

• Change employment

• Move to another location

• Develop new healthcare needs

• Change doctors

• Begin taking new medications

• Experience changes in household income

A change in circumstances may affect your healthcare coverage needs and the options available to you.

HEALTH INSURANCE & FINANCIAL PROTECTION

Health insurance is about more than paying medical bills. It can also help you manage the financial uncertainty that can accompany unexpected healthcare needs.

A major illness, accident, hospitalization, or ongoing treatment can place considerable pressure on a household budget.

Having appropriate health coverage can help you plan for eligible medical expenses with greater confidence.

HOW SECUREWAY INSURANCE CAN HELP

Choosing health insurance can feel complicated when you’re faced with unfamiliar terms, different plan structures, provider networks, and varying costs.

SecureWay Insurance focuses on helping you understand the important details before making a coverage decision.

We can help you consider:

• Your coverage priorities

• Available plan structures

• Provider networks

• Deductibles

• Copayments

• Coinsurance

• Prescription benefits

• Out-of-pocket limits

• Important exclusions and limitations

The objective is simple: help you understand your options so you can make a more informed insurance decision.

FREQUENTLY ASKED QUESTIONS

What is health insurance?

Health insurance is coverage designed to help pay for eligible healthcare expenses in accordance with the terms of a specific insurance plan.

What does health insurance usually cover?

Depending on the plan, coverage may include eligible preventive care, physician visits, hospital services, prescription medications, diagnostic services, and other healthcare expenses.

What is a health insurance deductible?

A deductible is generally the amount you pay toward eligible covered services before your health plan begins paying according to its terms.

What is coinsurance?

Coinsurance is generally your percentage of the cost of an eligible covered service after applicable deductible requirements have been met.

What is a copayment?

A copayment is a fixed amount you may pay for a particular covered healthcare service.

What is the difference between a premium and a deductible?

A premium is what you pay to maintain your insurance coverage. A deductible is what you may have to pay toward eligible covered services before the plan begins paying according to its terms.

Can I choose my own doctor?

That depends on the plan. Some plans offer greater provider flexibility than others. Always verify whether your preferred healthcare providers participate in the plan’s network.

Does health insurance cover prescriptions?

Many health plans include prescription drug benefits, but the medications covered and your share of the cost can vary by plan.

Can I have health insurance without employer coverage?

Depending on your circumstances and the coverage available in your location, you may have options for obtaining health insurance outside of an employer-sponsored plan.

Should I choose the plan with the lowest premium?

Not necessarily. A lower premium can sometimes come with a higher deductible or greater out-of-pocket costs. Consider the total potential cost of the plan alongside its benefits and network.

A SMARTER APPROACH TO HEALTH COVERAGE

Good health protection starts with understanding what you’re buying.

Whether you’re looking for individual coverage, family protection, or a plan that better fits your changing circumstances, taking time to compare costs, benefits, networks, and coverage limitations can make the decision easier.

SecureWay Insurance is here to help you approach health insurance with greater clarity and confidence.

Health insurance plans, benefits, premiums, deductibles, copayments, coinsurance, provider networks, eligibility requirements, exclusions, and limitations vary by insurer, location, plan, and individual circumstances. This page is provided for general informational purposes and does not guarantee coverage or benefits. The applicable policy or plan documents control the actual terms of coverage.