Insurance made simple: 6 must-know terms for smarter coverage Let’s be honest: Most of us never look at our health plan benefits until we actually need them, and by then, it’s too late to make a better choice. Sound familiar? But understanding your health plan is key to saving money and avoiding surprises. Before we get into the nitty-gritty of you picking a plan, you need to know the lingo. Here are the top six terms that will help you understand what your health insurance is saying. ● Summary of Benefits and Coverage (SBC): This is the cheat sheet for your health plan. It’s an easy-to-read summary of what’s covered, what you’ll pay for services and how your coverage works. ● Premium: Think of this as your monthly subscription, but for health care. You pay it biweekly through payroll, whether you use your plan or not. ● Deductible: The amount you pay out of pocket before your insurance starts to cover things. So if your deductible is $1,000, you’re footing the bill until you reach that amount. After that, your insurance joins the party. ● Co-pay: A flat fee you pay each time you visit the doctor or pick up a prescription. ● Co-insurance: Once you meet your deductible, your insurance starts paying, but not everything. You still have to pay a percentage (often 20%). So, if your hospital bill is $1,000, and you’ve already met your deductible, you’ll pay $200, and your insurance covers the rest. ● Out-of-pocket maximum: This is your financial safety net. It’s the most you’ll have to pay in a year. Once you hit this amount, your insurance pays 100% of covered services for the rest of the year. Source: Debbie Hankins, HealthEdge Administrators smarter coverage and savings —no regrets later! (except in emergencies), but with a PPO, you can see out-of-network providers—just expect to pay more. 3 Weigh the costs. Don’t just look at the premium! Factor in the deductible, co-pays, co-insurance and the out-of-pocket maximum. This will give you a clearer picture of what you’ll actually spend throughout the year. Master your health plan like a pro Don’t wait until you’re knee-deep in medical bills to learn about your health plan. By knowing these key terms and choosing the right plan from the start, you’ll save money and headaches later on. Plus, you’ll be able to make more informed choices when Open Enrollment rolls around. Source: Debbie Hankins, HealthEdge Administrators 2026 Open Enrollment starts Oct. 6, ends Nov. 7 Your Kern County Health & Wellness team is always available to answer your questions. Contact us by calling the phone number on the back of your insurance identification card or by visiting us at www.kerncountyhealthbenefits.com. ● Features a low deductible with 20% co-insurance. ● Uses the Anthem Network for nationwide coverage. ● Annual medical deductible: $250 member, $500 family. ● Annual prescription deductible: $100/member. ● Offers both in-network and out-of-network benefits. ● Uses the Anthem Network for nationwide coverage. ● Annual deductible: In-network, $0. Out-of-network, $200 member/$400 family.
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