Tag Archives: Deductibles

2013 HSA Contribution Limits

2013 HSA Contribution Limits

The IRS has recently announced the new contribution limits for HSA’s (Health Savings Accounts).

HSA contribution limits: 

  • Individuals (self-only coverage) – $3,250 (up $150 from 2012)
  • Family coverage – $6,450 (up $200 from 2012)

HDHP minimum required deductibles:

  • $1,250 for self-only coverage
  • $2,500 for family coverage

Out-of-pocket maximum:

(Out-of-pocket expenses include deductibles, co-payments, and other amounts, but not premiums)

  • $6,250 for self-only coverage
  • $12,500 for family coverage

Under guidelines implemented in the Patient Protection and Affordable Care Act, over-the-counter drugs may only be reimbursed if they have a prescription. If a policyholder uses an HSA to pay for items or services that aren’t qualified medical expenses, the tax penalty is 20 percent of the HSA distribution.

Understanding Common Health Insurance Terms

Understanding Common Health Insurance Terms

Whether you are searching for health insurance now or already enrolled in a plan, you may find the plan terms, or coverage descriptions, to be difficult to understand. Don’t worry. You are not alone.

Below is a list of common health insurance terms to help you understand what your health insurance plan has to offer:


The deductible refers to the amount of money the insured is required to pay out-of-pocket before accessing benefits from the insurance policy. Deductibles are usually setup on a policy (starting with the effective date of the policy) or calendar year basis, and start over each year. Some services, such as doctor visits and prescriptions, may be available without first satisfying the deductible. Usually there are separate individual and family deductible amounts. Many policies place a cap on the number of individual deductibles that need to be met for a family regardless of the number of family members.


After an insured’s deductible is met, most policies require the insured to pay a percentage of each claim. For example, with an 80% co-insurance plan, the insured would pay 20% of all bills once their deductible was satisfied.

Out-of-Pocket Max

In most cases, the out-of-pocket max refers to the maximum co-insurance that an insured is required to pay before the policy picks up 100% of eligible costs. Some policies include the deductible as part of the out-of-pocket maximum.

Lifetime Maximum

The amount of money the policy will pay during the life of the policy. This figure is often set at $1 million per insured, or some variation thereof, but some policies offer an unlimited lifetime maximum.


These are items or medical services that are not covered by the health plan.

Pre-existing Condition

A medical condition diagnosed prior to the effective date of the health plan. If someone can document at least 12 months of continuous coverage, most health plans are required under HIPAA to cover pre-existing conditions. Some policies, such as short-term or temporary plans, do not cover pre-existing conditions regardless of whether a person has had prior coverage.

Coordination of Benefits

If the insured has two or more insurance policies, such as being covered by a spouse’s insurance plan along with their own, that would cover payment for certain conditions, the the secondary insurer would pay only for expenses not covered by the primary insurer.

Medical Necessity

A medical procedure or service must be performed only for the treatment of an accident, injury or illness and is not considered experimental,
investigational or cosmetic.

Participating Provider

A physician or other medical provider has agreed to accept a negotiated fee for services provided to members of a specific health plan.  These
providers are often called “in-network.”

Usual & Customary Rate (UCR)

This is a reduction in the payment of benefits on a claim which is justified by the insurance company as “the going rate” in a certain
geographical area.

Allowed Amount

The amount of the billed charge the insurance company covers. For an in-network provider, this would be equal to the negotiated rate. For other providers, this might be based off a usual and customary rate for a given area.

Individual Health Insurance: Knowing What You’re Getting And Figuring Out What You Need

Individual Health Insurance: Knowing What You’re Getting And Figuring Out What You Need

While most Americans with health insurance are covered under an employer’s plan, there are still many employers that don’t have health insurance offerings. Workers of companies not offering insurance are left to find and purchase their own private individual health insurance directly from an insurer.

There are actually several advantages to purchasing private individual health insurance:

* Unlike those covered under an employer’s plan, you won’t just have a limited number of plans that were pre-selected by someone else to choose from. You, instead of your employer, get to determine what plan features are desirable and pick the plan that you see fit. By having a variety of plans available to you, such as those that don’t cover services you don’t want and that have higher deductibles, you can take advantage of lower premiums.

* Since private health plans are under your control, not your employer’s control, you also won’t have to worry about losing your coverage if you ever want to change jobs. As long as you pay your premiums when they’re due, the coverage is yours to keep and the insurer can’t drop you.

However, there are also several disadvantages to private health plan coverage, for example:

* Even if paying the same premium rates, individual plans usually provide less coverage than employer plans because individual policies have a larger percentage of the premium dollars going toward paying operational costs.

* The premiums for private health insurance plans increase as you age in most states. Since renewal rates tend to be higher than new policy rates, you can avoid the rate hikes for awhile by changing plans as rates become higher. However, this isn’t a long-term solution. Eventually, your age will make it more difficult to find an insurer and your individual policy will become more expensive.

* Group plans are typically required to insure all employees and their family members. On the other hand, if an applicant of an individual plan doesn’t have an ideal health status, then the insurer can reject the applicant.

If you do decide to go with private health insurance, then you’ll need to make sure that you work with the right insurance agent. Figuring out what type and what amount of insurance best meets your specific needs can be an overwhelming and confusing process. Having the right agent to help you assess your situation and apprise you of your options can be invaluable during the process. Being able to trust in your agent’s expertise and professional judgment and trusting that he/she will be working in your best interest are the keys to having a successful working relationship. Do remember that the agent also needs to be able to trust in you. So always make sure that any information you provide to your agent is honest and not withholding.

You will also want to keep a few questions in mind to ask your agent as you compare plans:

* What are the plan’s monthly premiums, coinsurance, and deductibles?

* What benefits does the plan offer?

* What pre-existing conditions affect my coverage?

* Is the doctor or hospital I want to use covered under the plan?

* If I use out-of-network providers, will there be additional fees or charges?

* How does the referral system operate?

* How is care handled should I need medical services when I’m away from home?

* Does the plan have a maximum amount it will pay over my lifetime or per year?

In closing, purchasing private market insurance isn’t as complicated as it might seem, but getting the right policy will take a little effort on your part. Remember to approach it just as you would any other major purchase – research all your options, do price and benefit comparisons, and seek expert advice and assistance.  — Brian Gruss 509-927-9200

Patriot Travel Medical Insurance

Patriot Travel Medical Insurance
Individual & family five days up to two years coverage

There are two Patriot Travel Medical Insurance products available to meet your needs, providing up to US$2,000,000 of medical coverage. Coverage can be obtained from a minimum of five days up to a maximum of two years. Patriot products address the travel medical insurance needs of U.S. citizens and foreign nationals who need temporary medical insurance while traveling for business or pleasure anywhere outside their home country. Coverage includes medical evacuation, repatriation, and your choice of deductibles and policy limits.