Allowances VS Coverage

Question Marks. What is the difference between allowance and coverage? Is there a difference?

Allowance is that thing you used to get from your parents for feeding the dog and taking out the trash every week, right? Yes, but not when it comes to health insurance. When we talk of “allowances” in the context of health insurance, we are referring to the maximum a plan will pay for a health-care treatment (i.e. chiropractic, dental, acupuncture, essential oils, etc).

Individuals receiving a maximum allowance of $3,600 ($7,200 for couples or families) as a Nova Pathfinder Healthcare member can spend up to $3,600 on services that are considered allowances and have those costs count toward their deductible, which is $5,000 for individuals ($10,000 for couples and families).

Once you have reached $3,600 in allowances ($7,200 for couples or families) and met your $5,000 deductible ($10,000 for couples and families), all expenses must be pre-authorized and submitted.

After the deductible is met, coverage is contingent on medical necessity, as authorized. Reimbursements will only be given once the deductible has been met and an authorization has been received. “Coverage” is not intended to pay for elective or preventive services. It provides a safeguard against financial disaster, should a major health crisis arise. 

 

Whether you’ve missed your open enrollment period or are looking for a healthcare coverage plan that better suits your lifestyle, signing up for Nova Pathfinder Healthcare is a simple and straightforward process.

Nova Pathfinder Healthcare is experiencing a temporary service outage for new members in the state of Idaho. For questions or to get a quote contact member services at 833-444-6682.