Health Insurance Terminology

Front

Health insurance helps pay for the costs of health care, making it more affordable for patients.

Back

Front

Deductible

Back

Amount that must be paid by the patient for health care services before the insurance policy begins to pay.

Front

Co-Insurance

Back

Mandates that specific percentages of expenses be paid by the patient and insurance company (e.g., 80-20 means the company covers 80% of covered expenses and the patient is responsible for the remaining 20%).

Front

Co-Payment

Back

The specific amount of money a patient pays at the time of service.

Front

Premium

Back

The amount of money the patient pays for health insurance each month.

Front

Fee-for-Service

Back

A health payment plan in which providers are paid a set price for each service they provide.

Front

Value-based Care

Back

A health payment plan that pays providers for their performance (quality, cost, patient outcomes).

Front

Out-of-Pocket Max

Back

The most amount of money you pay during a policy period (usually 1 year) before your insurance plan begins to pay 100%.

Front

Network

Back

The suppliers, providers, and facilities that a health insurer or plan has contracted with to provide health services.

Front

Pre-Authorization

Back

A decision made by your insurer or plan that a treatment, service, prescription, device, or equipment be covered ahead of time, due to being deemed medically necessary.