Glossary of Terms

Common Terms:

Catastrophic coverage:
Health insurance with a low monthly premium and a very high deductible. It can protect you from paying for an unexpected catastrophic illness or event, and instead you’ll pay for the routine medical expenses.

Claim: 
A health insurance claim is a request to the insurance company asking for a payment based on the terms of the insurance policy.

Copay:
A set price you pay when you receive care. Typical copays are for office visits, prescriptions, or hospitalizations.

Coinsurance:
After the deductible has been met, the coinsurance is a determined percentage of the cost of treatment the patient must pay for all covered medical expenses.

Deductible:
The amount of health care that the patient pays for before insurance will start paying for it. A high deductible plan typically means lower premium costs.

Disability income insurance:
This plan provides an income if the patient becomes unable to work due to an injury or illness. Benefits are typically around 60% of your income at the time of disability.

Health Savings Accounts:
A tax-deductible, tax-free interest account that an individual contributes to in order to pay for qualified healthcare expenses.

In-Network:
Doctors, health care professionals, clinics or hospitals that have a contract with your health insurance company to offer health care at set rates.

Long-term care policies:
These health insurance policies will cover most medical care if a patient is unable to care for themselves due to a long-term illness or disability.

Network:
A group of doctors, health care professionals, clinics and hospitals that have a contract with your health insurance company.

Out-of-Network:
When a doctor, clinic or hospital and an insurance company don’t have a contract allowing in-network access and lower pricing for a particular health plan’s members.

Out-of-Pocket Costs:
Expenses for health care that your health insurance company doesn’t pay. You will have to pay for these costs on your own.

Pre-existing condition:
A health condition that a person has when they sign up for health insurance.

Premiums: Your monthly or quarterly payment for your health insurance.

Primary Care Physician (PCP):
A doctor who helps you manage and get health care services.

Provider: A doctor, health care professional, clinic or hospital that provides care to a patient. These professionals and facilities are usually licensed, certified or accredited by state law.