Understanding Your Policy (2024)

Check your Evidence of Coverage

Every policy has a written Evidence of Coverage (EOC). The EOC is your guide to what is covered and what is excluded, how much you will pay depending on the circ*mstances, what your cost sharing will be, and other information about using your coverage. Keep this document handy for when you have questions about your policy.

What is an Explanation of Benefits?

Each time your insurer pays for a service you use, they send you an Explanation of Benefits (EOB). The EOB is your insurance company's written explanation for that claim, showing the name of the provider that covered the service and date(s) of service. The insurer is also required to send you a clear explanation of how they computed your benefits. This may include the amount billed, the allowed amount, what the insurer paid, and/or your share of the cost (if any).

Also, if any claims are denied or denied in part, you will receive a written explanation of the reason(s) for the denial. The EOB will usually show:

  • Billed amount: what the provider billed
  • Allowed amount: what the insurer allows for the service (sometimes shown as an "insurer discount" - i.e., if the billed charge is $50 higher than the insurer's allowed amount, the insurer discount would be $50),
  • Paid amount: what the insurer paid the provider
  • Patient's responsibility: patient's copay or deductible amounts, or whatever is left over that the patient has to pay. This is based on the plan's benefit design.

Depending on your plan and the service, EOBs may show more or less information.

Understanding Your Policy (2024)

FAQs

What is policy in your own understanding? ›

A policy is a set of ideas or plans that is used as a basis for making decisions, especially in politics, economics, or business. ... plans which include changes in foreign policy and economic reforms.

How to interpret an insurance policy? ›

How to read your insurance coverage
  1. Read the overview on your declarations page. ...
  2. Learn insurance terminology. ...
  3. Train your eagle eye and read the fine print. ...
  4. Ask yourself questions. ...
  5. See what's covered (your insuring agreement) ...
  6. See what's not covered (your exclusions)

How to analyze an insurance policy? ›

Closely Review the Exclusions, Limitations and Conditions

After the Insuring Agreements you're likely to find a section titled Exclusions. The Exclusions section tells you what is not covered under the policy. Interestingly, many commercial policies have important exclusions that are listed elsewhere!

What is in a policy summary? ›

This is a summary of the major promises of the insurance company and states what is covered. In the Insuring Agreement, the insurer agrees to do certain things such as paying losses for covered perils, providing certain services, or agreeing to defend the insured in a liability lawsuit.

Why is it important to understand policy? ›

Policies are important because they define what is, and is not acceptable in the organization. When created in the right way, they will ensure that all activities undertaken in the organization occur with the simple aim of ensuring the organization achieves its objectives.

What is the main point of policy? ›

Policies articulate goals that are narrower than strategic objectives and identify limits, or boundaries, for behavior and actions that are necessary to complete those goals.

How do you explain insurance for dummies? ›

At its core, insurance is a form of financial protection that helps cover the costs associated with various risks—be it a car accident, a house fire, or a medical emergency.

What is the simplest way to understand life insurance? ›

Life insurance is an agreement between you and your insurance company. You make regular payments, called premiums, and the insurance company pays your beneficiaries a tax-free lump sum when you pass away.

How do I read my life insurance policy? ›

The following details are usually included:
  1. Personal information: Review your date of birth, name, and any other information for errors.
  2. Benefit amount: The amount to be paid upon your death.
  3. Policy type: Specifies if you have a term or permanent policy.
Aug 23, 2024

What is the best way to describe insurance? ›

Insurance is a contract, represented by a policy, in which a policyholder receives financial protection or reimbursem*nt against losses from an insurance company. The company pools clients' risks to make payments more affordable for the insured.

How do you evaluate insurance? ›

The main factors on which you should evaluate insurance plans are premiums, life cover, CSR, convenience, customer service, and type of insurance. Note: You should also check the term insurance benefits if you are planning to purchase the term insurance plan.

What is a summary of a policy? ›

Policy summary means a synopsis describing the elements of a life insurance policy. Policy summary means the document summarising the Policy.

How to read an insurance policy? ›

How to Read an Insurance Policy
  1. 1) Ascertain who qualifies as an insured. ...
  2. 2) Confirm all forms and endorsem*nts are included. ...
  3. 4) Read the insuring agreement first. ...
  4. 5) Read the exclusions. ...
  5. 6) Read the exceptions to the exclusions. ...
  6. 7) When the policy refers to another section, read that section immediately.
Aug 1, 2019

How to read an insurance illustration? ›

How to read an insurance illustration
  1. Available index or fund choices.
  2. Initial premium allocations.
  3. Projections of cash value based on assumed investment performance.
  4. Risk disclosures.
  5. Guarantees.
  6. Policy fees.
  7. Participation rates and caps in the case of indexed universal life.
Sep 13, 2023

What is the simple definition of policy? ›

Policy is a law, regulation, procedure, administrative action, incentive, or voluntary practice of governments and other institutions. Policy decisions are frequently reflected in resource allocations.

What is policy term in simple words? ›

policy term in Insurance

The policy term is the lifetime of an insurance policy. The policy will also pay out if death occurs before the end of the agreed policy term. This policy will expire at 12:01 a.m. on the last day of the policy term. The policy term is the lifetime of an insurance policy.

What is the best meaning of policy? ›

: a definite course or method of action selected from among alternatives and in light of given conditions to guide and determine present and future decisions.

What is policy explaining? ›

A policy is a set of statements of principles, values and intent that outlines expectations and provides a basis for consistent decision-making and resource allocation in respect to a specific issue.

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