Health Insurance Terms
Below are some common health insurance terms. For more information contact us. We are here to work for you!
- COINSURANCE: The percentage of covered expenses under a major medical plan that will be paid once a deductible is satisfied OR a cost-sharing arrangement under which a covered person pays a specified percentage of the cost of a specified service, such as 20% of the cost of a doctor’s office visit.
- COPAY: A set fee for medical expenses that is required to be paid by the insured for specific services such as doctor’s office visits.
- DEDUCTIBLE: The initial amount of medical expenses an individual must pay before he/she will receive benefits under a medical expense plan.
- HMO: Health Maintenance Organization. Insureds are required to use a primary care physician in order to receive ANY benefits and there is a network to use.
- LIMITS: Maximum amount of benefit payable for a given situation or occurrence.
- OUT-OF-POCKET MAXIMUM (OOP): A present amount that the plan participant must pay before the insurance company pays 100% of the expenses.
- NETWORK: List of providers that a carrier has contracted to provide services to its insureds, at negotiated prices.
- OPEN ENROLLMENT: A period of time when eligible subscribers may enroll in, or transfer between, available programs providing health care coverage.
- OUTPATIENT SERVICES: Non-inpatient services, i.e., no overnight stay, provided by a hospital or other qualified facility, such as a mental health clinic, rural health clinic, mobile X-ray unit or free-standing dialysis unit. Those services include physical therapy, diagnostic X-ray and laboratory tests. Also included are doctor visits.
- PREFERRED PROVIDER ORGANIZATION (PPO): A health care arrangement between purchasers of care such as employers and insurance companies and providers offering benefits at a reasonable cost using incentives, such as lower deductibles and copays to get members to use providers within a network. Use of non-preferred physicians would involve a higher cost. Preferred providers must agree to specified fee schedules and are required to comply with certain utilization and review guidelines.
- PRIMARY CARE PHYSICIAN (PCP): Primary care physicians deliver basic or general care that is intended to be the patient’s first level of contact with the medical care system.
Need an insurance quote? Get in touch!
Access quotes from the most trusted insurance carriers. It’s comparison shopping at the click of a mouse.