Health Insurance Glossary
Here are some of the most common terms you will encounter when selecting and using health insurance:
Premiumthe amount you and/or your employer pays for health insurance. It can be paid monthly, quarterly or yearly.
Deductible the amount of money that must be paid out-of-pocket for a health care service before an insurer will start to pay
Co-payment fixed amount you pay when receiving a health service, such as a doctor visit or to receive prescription drugs
Co-insurancethe percentage an insured person pays for a service after a deductible is met. Your insurance pays the rest.
Networkthe hospitals, physicians and other health care providers your insurance has contracted with to provide health care services.
HMO (health maintenance organizations)managed care plans that have a closed network of providers you can visit. Most HMOs require you to have a primary care physician who will refer you to a specialist if needed.
PPO (preferred provider organization) – managed care plans that allow you to visit any doctor from a preferred network of hospitals and physicians. Under PPOs, you can visit a doctor out-of-network, but you will be charged more.
Out-of-network—health care providers not contracted to provide services to customers on a particular health plan
Out-patienta person who visits a hospital or clinic for medical services but does not require an overnight stay
Inpatienta person who is admitted to a hospital for at least one night for ongoing care
Mental Health Carethe diagnosis and treatment of mental illnesses, such as depression
More Complete Lists of Health Insurance Terms
- eHealth Insurance, a licensed health insurance agency, offers a Health Insurance Glossary.
- HealthCare.gov has a glossary of insurance terms.
- Healthinsurance.org, an independent internet website, provides a Health Insurance Glossary.
Resources reviewed June 2013
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