Health Insurance Terms and Definitions

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Health Insurance Terms and DefinitionsClaim – A submission from you to your provider requesting payment for medical services.

Coinsurance – A plan that requires you to pay a specific percentage of your expenses after your deductible.

Co-payment – What you pay, rather than the insurer, during a medical procedure.

Deductible – How much money you need to pay before your provider begins paying.

Indemnity plan – A general term for any plan that will pay your expenses as they occur.

Conventional indemnity plan – A type of indemnity plan which allows you to choose your doctors without an effect on how much your insurer will pay.

Disability Insurance – Insurance which will compensate you when you spend time unable to work due
to medical problems.

Healthcare provider – Someone (doctor) or a group (hospital) that offers medical help.

High-deductible health plan – A plan which requires you to pay a lot, but will therefore cover all costs beyond that. Also known as “catastrophic” insurance.

Long-term care insurance – This plan specifically covers hospice, nursing home, or in-home care.

Managed care – In the United States, managed care is a term used to describe cost-saving measures by the insurance company. For instance, your provider may require you to obtain a certification that you do need to visit a hospital before you go to avoid unnecessary medical procedures.

Network – A group of physicians and other medical providers who have been contracted by an insurance company. Medical professionals in your network will cost far less than those out of your network.

Maximum plan dollar limit – The most your insurer will pay for your healthcare costs, usually on a lifetime or yearly basis.

Maximum out-of-pocket expense – The most you will have to pay in a year. Beyond this point, your insurer will pay for all medical expenses, up to the maximum amount the policy will provide.