Health Insurance Vocab

A service where, in exchange for a monthly payment, the customer is protected from the financial costs of treating illness or injury

• health insurance

• car insurance

• insurance premium

• deductible

A contract that establishes what the customer must pay and do and what specific services or types of care the insurance company will pay for

• insurance policy

• premium

• deductible

• PPO

The money paid regularly by the patient for their insurance policy

• premium

• deductible

• copay

• coverage

The amount of money that the patient must pay themselves each year for healthcare before the insurance company will start to pay a portion

• deductible

• copay

• premium

• health insurance

Whatever services or treatments the insurance company will pay for

• coverage

• deductible

• copay

• premium

An insurance policy with medium cost and medium flexibility where the insurance company has negotiated with particular healthcare providers to get cheaper rates for their customers

• PPO

• HMO

• FFS

• Tricare

An insurance company with low premiums and low to no copays. They offer a strict list of providers you may see, and require your primary care doctor to give a referral before they will pay for any care from specialists

• HMO

• PPO

• FFS

• Tricare

An insurance policy with higher premiums and copays where the patient can see whomever they want without necessarily needing a referral

• FFS

• PPO

• HMO

• Tricare

Paying for one’s own medical care without the help of an insurance provider. AKA “uninsured”

• self-pay

• HMO

• PPO

• FFS

The fee that a policyholder pays for each doctor’s appointment or prescription

• copay

• premium

• deductible

• fee for service