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Learning the Lingo
Knowing these health insurance terms can help you understand what your health plan includes and how it works:
Benefits
Health care services covered with some level of payment by your insurance plan.
Claim
A request for payment.
Coinsurance
A percentage of the charges for a health care service that you pay.
Covered services
Medical services that are included in your health plan. (Also called benefits.) You and your insurer will share the cost of these services. Most covered services count toward your deductible and out-of-pocket maximum.
Deductible
The amount you pay each year before your insurance starts to pay. There are two types:
- Non-embedded deductible: Everyone on the plan shares one family deductible.
- Embedded deductible: Each family member has his or her own deductible, in addition to a shared family deductible.
Health insurance marketplace
A government-sponsored online store where multiple companies offer individual and family policies. If you qualify for financial assistance, you must buy your plan through the marketplace to receive it.
Health savings account (HSA)
A special bank account that lets you save tax-free dollars to cover the cost of medical expenses.
Network
A group of doctors, clinics, hospitals, pharmacies or other health care providers that contract with your health insurer to provide services to its members, generally at discounted rates.
Non-covered services
Medical services that are not included in your health plan. (Also called exclusions.) You pay the full cost of these services, and they don’t count toward your deductible or out-of-pocket maximum. Examples may include cosmetic procedures, experimental drugs and refractive eye surgery.
Out-of-pocket maximum
The most you will pay in a year for health care services covered by your insurance. Deductibles, copays and coinsurance are counted toward the out-of-pocket maximum, but premiums are not.