Health Insurance Terminology

 Health Insurance Terminology

Deductible: The amount of money you must pay out of pocket before your insurance kicks in.

Co-pay: A fixed amount you pay for each visit to a doctor, specialist, or hospital.

Co-insurance: The percentage of the cost of covered services that you are responsible for paying after you have met your deductible.

Out-of-pocket maximum: The maximum amount of money you will have to pay for covered services in a given year.

Premium: The amount you pay each month for your health insurance plan.

Provider: A healthcare professional or organization that provides medical services.

Network: The group of healthcare providers and facilities that are covered by your insurance plan.

In-network: Refers to healthcare providers and facilities that are part of your insurance plan's network.

Out-of-network: Refers to healthcare providers and facilities that are not part of your insurance plan's network.

Pre-existing condition: A medical condition that existed before you enrolled in your health insurance plan.

Health Savings Account (HSA): A tax-advantaged savings account that can be used to pay for qualified medical expenses.

Preferred Provider Organization (PPO): A type of health insurance plan that allows you to see any healthcare provider you choose, but offers greater benefits if you use providers within the plan's network.

Health Maintenance Organization (HMO): A type of health insurance plan that requires you to choose a primary care physician and typically only covers care received from providers within the plan's network.

Point of Service (POS): A type of health insurance plan that combines features of both PPO and HMO plans.

Explanation of Benefits (EOB): A statement from your insurance company that explains the healthcare services that were provided, the amount the provider billed, the amount your insurance covered, and the amount you are responsible for paying.

 


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