Allowances VS Coverage

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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; however, maybe we can turn it into some sort of a workable analogy. When referring to “allowances” as they apply to health insurance, we are talking about the maximum amount a plan will pay for a health care service (i.e. chiropractic, dental, essential oils, etc). As a NOVA Pathfinder member, individuals receive a maximum allowance of $3,600 ($7,200 for couples or families), which means they can spend up to $3,600 on services that are considered allowances under the NOVA plan and have those costs count toward their deductible, which is $5,000 for individuals ($10,000 for couples and families). But for comparison’s sake, let’s think of it this way: Say you earn $3,600 by feeding the dog and taking out the trash every week, and you decide to spend that on a new bike and a helmet (because you were a responsible 10-year-old who was looking out for his/her health even back then). Once your $3,600 is gone on that very expensive bike and helmet, you must get permission from your parents to buy knee pads and elbow pads. The same is true with health insurance allowances. 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. The same is true with health insurance allowances. 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. While it seems that allowances are part of your healthcare coverage, they are not. Allowances simply provide a way to pay down your deductible while utilizing preventative and wellness services that you probably already use on a regular basis. “Coverage,” on the other hand, is not intended to pay for elective or preventive services. Instead, coverage 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 Limited HealthCare is a simple and straightforward process.

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