800-686-4500

Ottawa

Phone:  

419-523-4500  

Bluffton

419-358-4600

Ottawa Office

614 N. Perry, St. Rt. 65

P.O. Box 364

Ottawa, OH 45875

Bluffton Office

115 N. Main St.

Bluffton, OH 45817

Fax:

419-523-0045

419-358-0046

Office Hours

Monday - Friday: 8:00a.m - 5:00p.m.

Evenings and Weekends:  By Appt.

Insurance Solutions | Ottawa, OH | Fortman Insurance Services 800-686-4500 staff

Co-insurance:

The amount you are required to pay for medical care in a fee-for-service plan and certain managed care plans after you have met your deductible.  The co-insurance rate is usually expressed as a percentage.  For example, if the insurance company pays 80% of the claim, you pay 20%. Some plans pay 100% after the deductible – the Health Savings Accouints medical plans have 100% coverage after the deductible.

Insurance Key Terms & Definitions

Agent:

Advisors who work with you to assess your insurance needs by helping plan for long-term financial security and stability.

Balance Billing:

A bill for the difference between what your insurer will pay and what the medical Provider charges for a service.

Coordination of Benefits:

A system to eliminate duplication of benefits when you are covered under more than one group plan.  Benefits under the two plans are usually limited to no more than 100% of the claim.

Co-payment:

A way of sharing medical costs.  You pay a flat fee every time you receive a medical service (for example, $30 for every visit to the doctor).  The insurance company pays the rest.

Covered Expenses:

Most insurance plans, whether they are fee-for-service or managed care plans, do not pay for all services that are medically necessary or for Preventive Care.  For more details as to what is a Covered Expense or an Exclusion of Coverage, please read your Policy thoroughly OR contact our insurance Team at Fortman Insurance. Covered services are those medical procedures the insurer agrees to pay for. They are listed in the policy.

Deductible:

The amount of money you must pay each year to cover your medical care expenses before your insurance policy starts paying.

Exclusions:

Specific conditions or circumstances for which the policy will not provide benefits.

Managed Care:

The way a health care system manages costs, use, and quality.  All HMOs and PPOs, and even many fee-for-service plans, apply managed care techniques.

Maximum Out-of-Pocket:

The maximum amount of money you will be required pay a year for deductibles and coinsurance. It is a stated dollar amount set by the insurance company, in addition to regular premiums.

Non-cancellable Policy:

A policy that guarantees that you will receive insurance as long as you pay the premium. This is also known as a guaranteed renewable policy.

Pre-existing Condition:

A health problem that existed before the date your insurance coverage became effective.

Premium:

The amount you or your employer pay, in addition to co-payments, coinsurance and deductibles, in exchange for insurance coverage.

Primary Care Physician:

A primary care physician monitors your health, diagnoses and treats minor health problems, and refers you to specialists if another level of care is needed. This is often a family physician or internist, but some women prefer to use their gynecologist.

Provider:

Any person (doctor, nurse, dentist) or institution (hospital or clinic) that provides medical care.

Third-Party Payer:

Any payer for health care services other than you. This can be an insurance company, an HMO, a PPO, or the Federal Government.