Half the battle in understanding health insurance is figuring out
the lingo and keeping all the terms straight. Here's a glossary with
the most-used terms, also posted on each article page.
Co-Insurance: refers to money that an individual is required
to pay for services, after a deductible has been paid. In some health
care plans, co-insurance is called "co-payment." Co-insurance
is often specified by a percentage. For example, the employee pays
20 percent toward the charges for a service and the employer or insurance
company pays 80 percent.
Co-Payment: a predetermined flat fee that an individual pays
for health care services, in addition to what the insurance covers.
For example, some HMOs require a $10 "co-payment" for each
office visit, regardless of the type or level of services provided
during the visit.
Covered Expenses: What the insurance company will consider
paying for as defined in the contract. For example, under some plans
generic prescriptions are covered expenses, while brand name prescriptions
may be covered at a different reimbursement rate or not at all.
Deductible: The amount an individual must pay for health
care expenses (typically $100, $250 or $500) that an insured individual
must pay before benefits are paid by the insurance plan. Often, insurance
plans are based on yearly deductible amounts.
Dependents: Spouse and/or unmarried children (whether natural,
adopted or step) of an insured person.
Group Insurance: Coverage through an employer or other
entity that covers all individuals in the group.
Health Maintenance Organizations (HMOs): "pre-paid" insurance
plans in which individuals or their employers pay a fixed monthly
fee for services, instead of a separate charge for each visit or
service. The monthly fees remain the same, regardless of types or
levels of services provided, Services are provided by physicians
who are employed by, or under contract with, the HMO. HMOs vary in
design. Depending on the type of the HMO, services may be provided
in a central facility, or in a physician's own office.
Indemnity Health Plan: Also called "fee-for-service." These
are the types of plans that primarily existed before the rise of
HMOs, IPAs, and PPOs. With indemnity plans, the individual pays a
pre-determined percentage of the cost of health care services, and
the insurance company pays the other percentage. For example, an
individual might pay 20 percent for services and the insurance company
pays 80 percent. The fees for services are defined by the providers
and vary from physician to physician. Indemnity health plans offer
individuals the freedom to choose their health care professionals.
Out-Of-Pocket Maximum: The most money you can expect to pay
for covered expenses. The maximum limit varies from plan to plan.
Some companies count deductibles, co-insurance, or co-payments toward
the limit, others don't. Once the maximum out-of-pocket has been
met, many health plans pay 100% of certain covered expenses.
Open Enrollment: A specified period of time in which employees
may change insurance plans and medical groups offered by their employer,
without proof of insurability. Open enrollment usually occurs once
a year.
Pre-existing Condition: Unfortunately, there's no clear-cut
definition of this term; each insurance company has a different way
of looking at it. Generally speaking, it's a medical condition that
was first treated or has manifested itself prior to your enrollment
in a plan. Some plans completely exclude pre-existing conditions
from coverage; others may have a waiting period of six months to
a year. You should check the plan carefully or talk to your insurance
agent if you think you may have such a condition.
Preferred Provider Organizations (PPOs): You or your employer
receive discounted rates if you use doctors from a pre-selected group,
or “in-network”. If you use a physician outside the PPO
plan, you must pay more for the medical care.
Premium: The money paid to an insurance company for coverage.
Premiums area typically paid monthly, or semi-annually.
Small Employer Group: Generally means groups with 1-99 employees.
The definition may vary between states.
Stop-loss: The dollar amount of claims filed for eligible
expenses at which point you've paid 100 percent of your out-of-pocket
and the insurance begins to pay at 100 percent. Stop-loss is reached
when an insured individual has paid the deductible and reached the
out-of-pocket maximum amount of co-insurance.
Health
Alliance right prescription for uninsured musicians Nearly
500 musicians have signed up for care this year, provided by Austin's
Health Alliance for Austin Musicians Austin American Statesman, March 13, 2006
Musicians who
juggle jobs say latest cuts are too great Shreveport Symphony musicians struggle with paycuts and reductions in health
insurance coverage Shreveport Times, February 14, 2006
Coverage and Access
NPR's Ed Gordon interviews David Nathan, chair of the R&B Foundation,
about the lack of health insurance coverage among many musicians. According
to Nathan, many people assume that recording and performing artists "have
some huge amount of money that they generate, but that's just not the case.
NPR's News and Notes with Ed Gordon January
20, 2006
Soundman Versus Flesh-Eating Bacteria. His next challenge: a six-figure
medical bill Chicago musicians organize benefits to help soundman Gary Schepers Chicago Reader, January 6, 2006
Band Aid: Musicians Taking Care of their Own Chicago musicians and labels organize benefits to help soundman Gary Schepers Chicago Tribune, January 20, 2006
Most Temp, Part-Time Workers Lack Job-Linked Health Insurance
Commonwealth Fund study shows that only 21 percent of America's 34 million
part-time workers have health insurance from their job. Forbes, December 1, 2005
A New Pension for Struggling Artists Though it's about visual artists, an interesting article about artists pooling
their resources to create long-term security.
by Julie Salamon New
York Times, July 20, 2004
Band Aid for an Ailing Musician Almost 90 percent of the musicians surveyed
had played a benefit for another musician, though even the most successful
benefit seldom makes more than a symbolic dent in typically huge
health care debts.
By Richard Harrington Washington Post, April 9, 2004
Health Insurance Crisis Lingers for Biz The number of uninsured musicians remains high
By Chris Morris Billboard, March 13, 2004
Songs in the Key of Major Medical
By Peter Margasak Chicago Reader, November 28, 2003
Chic drummer Tony Thompson dies Thompson, who was also one of the world's most famous session musicians,
died of renal cancer. A fund was set up to help Thompson with medical bills
last week, as the drummer had no medical insurance. NME, November
14, 2003
Health Care for Recording Artists? In 2003, AFTRA approved an agreement with BMG,
EMI Music, Sony Music Entertainment, Universal Music Group, and Warner
Music Group. The agreement
would make available health care insurance to all union-affiliated performing
artists under exclusive contract to a recording label, for the duration
of their contracts.
By Barry Willis Stereophile, October 6, 2003
Disclaimer: Future of Music Coalition provides basic
health insurance information to answer your basic health insurance option
questions. Insurance is regulated on a federal basis and by each state,
and each insurance carrier rules and policy terms may differ from state
to state and between individuals. Therefore, you acknowledge and agree
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is general information only, and may not apply to your particular situation.
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of service
Fractured
Atlas is a nonprofit service organization for artists and
creators. One of the benefits they offer their members is access
to group health insurance. Visit the website and select your
state from the menu to see the state-specific insurance options.
Membership in the organization is $75 annual for an individual, but
there are also affordable group rates starting at $150.
AHIRC:
The Artists’ Health Insurance Resource Center is an
online database created by the Actors’ Fund with a grant from
the National Endowment for the Arts. Data is organized by state
and includes information about resources in each state for artists,
and lists of insurers of all kinds. Access to this data is
free.
Health
Alliance for Austin Musicians If you are an uninsured,
professional musician in the Austin, TX area, you may be eligible
for low-cost primary health care services, basic dental care and
mental health counseling provided by HAAM.
SIMS Foundation is
a non-profit organization that provides access to low-cost mental
health services for Austin, TX musicians and their immediate families.
Texas Music Office is a state-funded business promotion and information clearinghouse for the musicians of Texas. The insurance page provides a detailed list of health insurance options for residents of Texas.
A
Consumer Guide for Getting and Keeping Health Insurance Created
by the Georgetown University Health Policy Institute, this website
provides legal information about your rights as a health insurance
consumer for each state. Updated regularly.
eHealthinsurance.com A
for-profit broker that consolidates information about plans and premiums
on their website.
