Individual & Family

Individual & Family

Policies for people that aren't connected to job-based coverage. Individual and family health insurance is the same kind of policy. A family plan is a policy that can cover multiple people within a family. There is one main policy holder but each member of the family is listed under the primary policy holder.

Plan Definitions

PPO – A type of health plan that contracts with medical providers, such as hospitals and doctors, to create a network of participating providers. You pay less if you use providers that belong to the plan’s network. You can use doctors, hospitals, and providers outside of the network for an additional cost.

POS - A type of plan in which you pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network. Similar to a PPO, you can use providers outside of the network but will cost more.

HMO - A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally won't cover out-of-network care except in an emergency.

HSA (Health Savings Account) - A medical savings account available to taxpayers who are enrolled in a High Deductible Health Plan. The funds contributed to the account aren't subject to federal income tax at the time of deposit. Funds must be used to pay for qualified medical expenses. Unlike a Flexible Spending Account (FSA), funds roll over year to year if you don't spend them.

Copayment - A fixed amount (for example, $30) you pay for a covered health care service, usually when you get the service. The amount can vary by the type of covered health care service.

Deductible - The amount you owe for covered health care services before your health insurance or plan begins to pay. For example, if your deductible is $1,000, your plan won’t pay anything until you’ve met your $1,000 deductible for covered health care services subject to the deductible. The deductible may not apply to all services.

Co-Insurance - Your share of the costs of a covered health care service, calculated as a percent (for example, 20%) of the allowed amount for the service. You pay coinsurance plus any deductibles you owe. For example, if the health insurance or plan’s allowed amount for an office visit is $100 and you’ve met your deductible, your coinsurance payment of 20% would be $20. The health insurance or plan pays the rest of the allowed amount.

Preferred (In- Network) Provider - A provider who has a contract with your health insurer or plan to provide services to you at a discount.
*Always check either the provider directory, or call your doctor to make sure they accept the insurance you are planning on going into*

Non-Preferred (Out-of-Network) Provider - A provider who doesn’t have a contract with your health insurer or plan to provide services to you. You’ll pay more to see a non-preferred provider.
*Always check either the provider directory, or call your doctor to make sure they accept the insurance you are planning on going into*

Max Out-of-Pocket - The most you pay during a policy period (usually one year) before your health insurance or plan starts to pay 100% for covered essential health benefits. This limit must include deductibles, coinsurance, copayments, or similar charges and any other expenditure required of an individual which is a qualified medical expense for the essential health benefits. This limit does not have to count premiums, balance billing amounts for non-network providers and other out-of-network cost-sharing.

The maximum out-of-pocket cost limit for any individual plan for 2017 in-network can be no more than $7,150 for an individual plan and $14,300 for a family plan.