Health Insurance Glossary
Coinsurance: Amount you are responsible to pay for the medical care services in a fee-for-service plan after the deductible is reached. The coinsurance is typically listed as a percentage. For instance, if your health insurance company pays for 75%, you will need to pay 25% of the costs after the deductible.Coordination of Benefits: A method of getting rid of benefits from more than one group plan you are covered under.
Copayment: This is the flat fee amount you must pay everytime you receive a medical service and the health insurance company pays the rest. This flat fee is designed so that you are responsible to pay some amount so you don't abuse the insurance and visit the doctors for every little issue when you normally would not need to.
Covered Expenses: Insurance companies normally don't pay for all services. Covered expenses are the medical expenses that will be covered under your health insurance plan.
Deductible: The amount you must pay annually before your insurance policy kicks in when it comes to covering medical expenses. Normal deductibles are $500 or $1,000.
Maximum Out-of-Pocket: The maximum amount you will need to spend on insurance deductibles and coinsurance. This is usually a dollar amount that is set by the health insurance company. The limit does not factor in the health premium you pay.
Noncancelable Policy: A health policy that will guarantee you get insurance coverage as long as you keep up to date on paying the premium. Also known as guaranteed renewable policy.
Premium: The amount you and/or your employer pays for insurance coverage.
Primary Care Doctor: Typically will be your first contact for anything relating to health care that you'll need to be covered by your insurance. The doctor can refer you to specialist if the health problem calls for it.
Provider: Any party such as a doctor, dentist or nurse as well as institution such as hospitals and clinics that provide medical care.