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A recent meeting with a client reminded me that while the vocabulary of our industry may be second nature to those of us in the industry, it may feel like a foreign language, creating the first barrier to understanding, for those of you trying to navigate the health insurance arena. Therefore, today we will offer a user-friendly listing of the terms you may encounter.

PREMIUM – The money you pay to have an insurance product. Similar to when you check out at the grocery store and pay for your sacks of groceries, premium is what you pay for the product you purchased.

DEDUCTIBLE – Deductible is the amount of money you will pay out of your pocket before the health insurance plan starts to pay. Deductibles can vary by carrier, and plan. The Medicare Part A (Hospital coverage) deductible in 2014 is $1,216 per benefit period. The Medicare Part B (Medical IE: Doctor appointments etc) deductible in 2014 is $147 per year. If your current health insurance is through an employer, you may have a deductible as low as $250 or as high as $5,000. Most deductibles these days are per calendar year.

COBRA - Consolidated Omnibus Budget Reconciliation Act (COBRA) is a federal law that may allow you to temporarily keep health coverage after your employment ends, you lose coverage as a dependent of the covered employee, or another qualifying event. If you elect COBRA coverage, you pay 100 percent of the premiums, including the share the employer used to pay, plus an administrative fee.

CO-PAY – (Copayment) - An amount you may be required to pay as your share of the cost for a medical service or supply, like a doctor's visit, hospital outpatient visit, or prescription drug. A copayment is usually a set amount, rather than a percentage. For example, you might pay $10 or $20 for a doctor's visit or prescription.

COINSURANCE - An amount you may be required to pay as your share of the cost for services after you pay any deductibles. Coinsurance is usually a percentage (for example, 20 percent).

EOB – Explanation of Benefits. The Explanation of Benefits (EOB) is the insurance company’s written explanation regarding a claim, showing what they paid and what the client must pay. The document is sometimes accompanied by a benefits check.

MSN – Medicare Summary Notice. Medicare Summary Notice (MSN) A notice you get after the doctor or provider files a claim for Part A or Part B services in Original Medicare. It explains what the doctor or provider billed for, the Medicare-approved amount, how much Medicare paid, and what you must pay. It is the same concept as an EOB, but is the notice you receive from Medicare.

COVERAGE GAP – relative to Medicare Part D (also known as the "Donut Hole") A period of time in which you pay higher cost sharing for prescription drugs until you spend enough to qualify for catastrophic coverage. The coverage gap (also called the "donut hole") starts when you and your plan have paid a set dollar amount for prescription drugs during that year.

PRIOR AUTHORIZATION – The definition from the Medicare website for this term reads as follows: approval that you must get from a Medicare drug plan before you fill your prescription in order for the prescription to be covered by your plan. Your Medicare drug plan may require prior authorization for certain drugs. However, from a non-Medicare insurance site we see the following definition: Prior authorization is a decision by your health insurer or plan that a health-care service, treatment plan, prescription drug, or durable medical equipment is medically necessary. Sometimes called pre-authorization, prior approval, or pre-certification. Your health insurance or plan may require prior authorization for certain services before you receive them, except in an emergency. Prior authorization isn’t a promise your health insurance or plan will cover the cost.

SAINT JOHN, N.B. – Consumers are encouraged to learn how to spend smart and spend safe during Fraud Prevention Month. The Financial and Consumer Services Commission is providing resources to New Brunswickers to help.

"Whether you are shopping at the mall or making purchases online, you should be looking at how you can spend smartly and safely," said Andrew Nicholson, director of education and communications with the commission. "During March, we will be offering tips and free resources to help empower you to make the right financial decisions, no matter where or how you are spending your money."

Commission staff will be available at several home shows, scam jams and presentations around the province during the month. The schedule is online.

"Sometimes we need a reminder to think twice before handing over our hard-earned money," said Nicholson. "Protecting your money can be as easy as asking questions about return policies before you buy or checking the licence or registration of someone selling you insurance or investments. We can take small, but important, steps to protect ourselves."

Each week of the month has a theme reflecting the activities taking place:

– March 8 – International Women's Day event: Pathways to Empowerment, Delta Brunswick Hotel, 39 King St., Saint John.

– March 11 – Too Good To Be True Day. New Brunswickers will be encouraged to use the hashtag #2Good2BTrue to get tips and information from Fraud Prevention Forum members across Canada on recognizing and avoiding frauds and scams. Follow the commission on Twitter: @4NBInvestors.

– March 19 – Check Registration Day. New Brunswickers will be encouraged to check the registration of their financial adviser. Checking registration is a quick and easy first step you can take to protect your investments. Scam jams are scheduled in Saint John, Moncton and Fredericton this week.

The commission encourages New Brunswickers to take the time now to improve their financial health. Find free tools and resources on spending and saving, investing, insurance, pensions and more online.

The Financial and Consumer Services Commission regulates, educates and protects consumers and investors from unfair, improper or fraudulent practices. It brings together regulatory authorities for securities, insurance, pensions, consumer affairs, co-operatives, credit unions, caisses populaires and loan and trust companies. It is an arm's-length Crown corporation funded by the fees and assessments paid by the regulated sectors.

Insurance investigators research and verify claims to make sure no fraud or cheating is involved. They search records and databases, conduct personal interviews and inspect damaged vehicles, property and buildings. They also write reports of their findings and cooperate with other investigators and law enforcement professionals. Although investigator jobs often require only a high school diploma, many hiring managers prefer candidates with relevant work experience or education. Some investigators must be licensed.

High School

Insurance companies usually require a high school education or the equivalent for insurance investigator jobs, according to the U.S. Bureau of Labor Statistics. Take speech classes or join the debate club in high school to develop the interviewing skills you will need as a future investigator. Take courses in English and writing to prepare for the report-writing component of an investigator's career.

College Training

Some insurance companies prefer to hire investigators with college degrees, although no degree is mandatory. The desired degree varies with the type of claims work. For example, an engineering degree is useful for investigating claims in factories, while an accounting degree equips you to investigate business fraud. A bachelor's degree in criminal justice is another path to the job of insurance investigator. A criminal justice program provides a legal background plus the necessary skills in research, investigation and critical thinking.

More At:

Investigator Education at Koyal Group

Insurance Fraud Certified at Koyal Group

NEW YORK — A whistle-blower will be paid $63.9 million for providing tips that led to JPMorgan Chase & Co's agreement to pay $614 million and tighten oversight to resolve charges that it defrauded the government into insuring flawed home loans.

The payment to the whistle-blower, Keith Edwards, was disclosed on Friday in a filing with the U.S. district court in Manhattan that formally ended the case.

In the Feb. 4 settlement, JPMorgan admitted that for more than a decade it submitted thousands of mortgages for insurance by the Federal Housing Administration or the Department of Veterans Affairs that did not qualify for government guarantees.

JPMorgan said it had failed to tell the agencies that its own internal reviews had turned up problems.

The government said it ultimately had to cover millions of dollars of losses when some of the bank's loans went sour, resulting in evictions and foreclosures nationwide.

“There were a lot of bad loans made during the financial boom, and the United States taxpayer was left holding the bag through the VA and FHA loan programs,” said Edwards' lawyer, David Wasinger. “Hopefully the settlement sends a message to Wall Street that this conduct is not allowed, and that in the future it will be held accountable.”

Edwards could not immediately be reached for comment.

About $56.5 million of Edwards' award concerns the FHA portion of the case, and $7.4 million concerns the VA portion. Wasinger declined to discuss his legal fees.

Edwards, a Louisiana resident, had worked for JPMorgan or its predecessors from 2003 to 2008, and had been an assistant vice president supervising a government insuring unit.

He originally sued in January 2013 under the federal False Claims Act, which lets individuals sue government contractors and suppliers for allegedly defrauding taxpayers. The Department of Justice later joined as a plaintiff.

Whistle-blowers can recover portions of False Claims Act settlements, which often grow if the government gets involved.