February 2017 Newsletter




Health Insur­ance Terms 


From time to time, nation­al sur­veys are con­duct­ed ask­ing adults to define some “basic” health insur­ance terms: deductible, copay, coin­sur­ance, and out-of-pock­et max­i­mum. The results illu­mi­nate the need for clar­i­ty and education

what is a frag­ment­ed and com­plex health­care sys­tem. Hous­ton
Chron­i­cle: Con­fu­sion reigns among health insur­ance shoppers


As the arti­cle above states, only 5% in Hous­ton cor­rect­ly defined all four terms. 42% nation­al­ly said they were not con­fi­dent they could pick the right plan for them when pre­sent­ed with options.  In a sim­i­lar 2013 sur­vey, more than half of the adults sur­veyed (51%) could not accu­rate­ly iden­ti­fy at least one of pre­mi­um, deductible, copay.

And yet, these terms are the cor­ner­stones to how we typ­i­cal­ly com­pare plans.  Amer­i­cans are pick­ing plans that, with­out the right information, can be leav­ing them gross­ly over-insured or under-insured.  And yet, the amount Amer­i­cans spend out of their own pock­et is often sig­nif­i­cant to their fam­i­ly’s bottom-line.

The lack of clar­i­ty for such a high-bud­get item is lead­ing toward an epi­dem­ic, and high­lights the need for health con­sumer edu­ca­tion.  Here are the def­i­n­i­tions for some of they key terms, includ­ing those surveyed:

How much you have to spend for cov­ered health ser­vices before your insur­ance com­pa­ny pays any­thing (with excep­tion to free pre­ven­tive ser­vices).  If your plan sum­ma­ry shows that the deductible is waived for a par­tic­u­lar ser­vice, you will pay that copay or coin­sur­ance with­out hav­ing to meet the deductible first.


Copay­ments and Coin­sur­ance:
Pay­ments you make each time you get a med­ical ser­vice after reach­ing your deductible.  If you have a plan with no deductible, the copays and/or coin­sur­ance go into effect right away.  If the plan sum­ma­ry shows a per­cent­age, that is your coin­sur­ance.  You the mem­ber will always pay the amount 50% or low­er (so, if the plan sum­ma­ry shows 70%, you the patient are respon­si­ble for the remain­ing 30%).


Out-of-pock­et max­i­mum:
The most you have to spend for cov­ered ser­vices in a year.  For most plans this is a cal­en­dar year, but it could be the plan year of your employ­er, for exam­ple.  Seek this clar­i­fi­ca­tion if you aren’t sure. After you reach this amount, the insur­ance company pays 100% for cov­ered ser­vices until the next plan or cal­en­dar year starts.


The amount you pay for your health insur­ance every month.  This is essen­tial­ly the cost you must pay just to access and have health­care ben­e­fits (it is sep­a­rate from the deductible, copays, coin­sur­ance, etc.)  A por­tion (or all) may be paid for by your employer. The plan with bet­ter ben­e­fits (typ­i­cal­ly) has a high­er premium.


The above arti­cle is writ­ten by Arrow Prin­ci­pal Stephen McNeil. You can read more about the U.S. and state health­care sys­tem on his web­site at




100 Sono­ma Peo­ple Who Care



Prin­ci­pal, Mari­ah Shields non-prof­it — 100 Sono­ma Peo­ple Who Care — in the news!


Shields is the Sono­ma chap­ter co-founder & chair — the con­cept is sim­ple: Gath­er 100 peo­ple and have each one bring $100 to donate to a wor­thy non­prof­it organization; 

invite three to five eli­gi­ble non­prof­its to present at the meet­ing; each non­prof­it pro­vides a one per­son, four-to-five-minute oral pre­sen­ta­tion — each attend­ing mem­ber of the

group has one vote and must pro­vide their $100 dona­tion regard­less of what orga­ni­za­tion wins; the non­prof­it that secures the most votes is gift­ed the entire amount raised. Read
entire arti­cle here…