Health Insurance Terminology 1

Form of cost-sharing between the member and the insurance company. An insured individual pays a percentage of the cost of covered medical services, and the insurance company pays a percentage.

• Coinsurance

• Copayment

• Deductible

• Coordination of Benefits (COB)

Form of cost-sharing whereby an insured person pays a specified flat amount per unit of service or unit of time (for example $15 per visit, $100 per day) while the insurer pays the remaining costs.

• Discount

• Deductible

• Cost Sharing

• Copayment

A set dollar amount that a person must pay before insurance coverage for medical expenses can begin

• Deductible

• Discount

• Out-of-Pocket Maximum

• Excluded Services

The fee paid to a health insurance carrier by an enrolled company or individual, normally on a monthly basis, for the delivery and financing of healthcare services to the employees or the individual, and their dependents enrolled in the plan

• Balance Billing

• Premium

• Coinsurance

• Discount

The maximum amount that an insured person will have to pay for covered expenses under the plan, usually within the plan effective dates.

• Rollover

• Contract Year Plan

• Copayment

• Out-of-Pocket Maximum