Serving Nevada Residents
and Business Owners with
Affordable and Dependable Insurance

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               241 Sunpac Ave | Henderson, NV 89011

Phone: (702) 565-4000 | Fax: (702) 450-3860

Business | Home | Auto | Health | Life

Health Insurance

Health Insurance and Employee Benefits are always changing and are among your largest expenses. We know that keeping your family and employees healthy is essential to their well being. We offer many ways to protect families and business from unexpected illness and injury.

Definitions of Health Insurance Terms

Coinsurance

A form of medical cost sharing in a health insurance plan that requires an insured person to pay a stated percentage of medical expenses after the deductible amount, if any, was paid.

Once any deductible amount and coinsurance are paid, the insurer is responsible for the rest of the reimbursement for covered benefits up to allowed charges: the individual could also be responsible for any charges in excess of what the insurer determines to be “usual, customary and reasonable”.

Coinsurance rates may differ if services are received from an approved provider (i.e., a provider with whom the insurer has a contract or an agreement specifying payment levels and other contract requirements) or if received by providers not on the approved list.

In addition to overall coinsurance rates, rates may also differ for different types of services.

Copayment

A form of medical cost sharing in a health insurance plan that requires an insured person to pay a fixed dollar amount when a medical service is received. The insurer is responsible for the rest of the reimbursement.

There may be separate copayments for different services.

Some plans require that a deductible first be met for some specific services before a copayment applies.

Deductible

A fixed dollar amount during the benefit period – usually a year – that an insured person pays before the insurer starts to make payments for covered medical services. Plans may have both per individual and family deductibles.

Some plans may have separate deductibles for specific services. For example, a plan may have a hospitalization deductible per admission.

Deductibles may differ if services are received from an approved provider or if received from providers not on the approved list.

Preferred provider organization (PPO) plan

An indemnity plan where coverage is provided to participants through a network of selected health care providers (such as hospitals and physicians). The enrollees may go outside the network, but would incur larger costs in the form of higher deductibles, higher coinsurance rates, or nondiscounted charges from the providers.

Health maintenance organization (HMO)

A health care system that assumes both the financial risks associated with providing comprehensive medical services (insurance and service risk) and the responsibility for health care delivery in a particular geographic area to HMO members usually in return for a fixed prepaid fee. Financial risk may be shared with the providers participating in the HMO.

       
       
       

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