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Health Insurance Terms

The following is a compiled list of important terms and definitions you will need to know in order to understand your health insurance coverage and policy information:

  • Deductible – The amount of covered medical expenses that are paid by each covered person during the Policy Year before benefits are paid.
  • Coinsurance – The percentage you are required to pay after your deductible and copayment of the allowed amount for health care services.
  • Copay – This is a fee charged to a person for covered medical expenses.
  • Preferred Care Provider – A health care provider that has contracted to furnish services or supplies for a negotiated charge, but only if the provider is, with your health insurance company’s consent, included in the directory as a preferred care provider.
  • Out-of-Network Provider – A provider that does not contract with your health insurance company. The benefit paid is lower than the benefit paid for a preferred provider.
  • Out-of-Pocket Costs – The expenses you pay for your health care that are not reimbursed by your insurance plan. Out-of-pocket costs include deductibles, coinsurance, and copayments for covered services.