Top 5 Need-to-Know Health Plan Terms

Along the path to choosing a health plan that meets your needs, you will encounter many insurance terms and phrases, and it’s to know what each one means. At GuideStone^®, our goal is to equip you with the information you need to make the best decisions for you and your family.

Here are the top 5 terms you need to know:

Deductible

A deductible is the amount you pay out-of-pocket before co-insurance takes effect and is often the associated number with your plan. If your deductible is $1,000, that means you need to pay $1,000 on health care services before the plan starts covering the co-insurance percentage for the rest of the year. The lower the deductible, the faster you get covered at the co-insurance level.

Co-Insurance

After you meet your deductible, co-insurance is the split between what you and your health plan pay for eligible claim expenses. For example, if your plan has 80/20 co-insurance, that means the plan pays 80% of the claim, and you pay 20%.

Preventive Care

Preventive care includes routine procedures such as check-ups, screenings and immunizations. Every GuideStone plan covers 100% of preventive care. This means these services are at no cost to you! Taking care of yourself today can help your quality of life later.

Co-Pay

While some services like preventive care are 100% covered, other services have co-pays. A co-pay is the fixed amount you pay onsite for certain in-network expenses like a primary care visit or urgent care.

Maximum Out-of-Pocket (MOOP)

The maximum out-of-pocket, or MOOP, is the absolute maximum you will pay under a plan, including your deductible, co-pays and prescription costs. Once you reach this limit, the plan pays 100% of your claims.

GuideStone is here to help equip you and your ministry for Christ-centered well-being. We know that can be a complex task, but our team is always here to guide you through these discussions. Visit GuideStone.org/Insurance or call us Monday through Friday, from 7 a.m. to 6 p.m. Central Time.