HEALTH INSURANCE: GLOSSARY OF COMMON TERMS
Here are some of the most common terms you will encounter when selecting and using health insurance:
Premium: the amount you and/or your employer pays for health insurance. It can be paid monthly, quarterly or yearly.
Deductible: the amount of money that must be paid out-of-pocket for a health care service before an insurer will start to pay
Co-payment: fixed amount you pay when receiving a health service, such as a doctor visit or to receive prescription drugs
Co-insurance: the percentage an insured person pays for a service after a deductible is met. Your insurance pays the rest.
Network: the hospitals, physicians and other health care providers your insurance has contracted with to provide health care services.
HMO (health maintenance organizations): managed care plans that have a closed network of providers you can visit. Most HMOs require you to have a primary care physician who will refer you to a specialist if needed.
PPO (preferred provider organization): managed care plans that allow you to visit any doctor from a preferred network of hospitals and physicians. Under PPOs, you can visit a doctor out-of-network, but you will be charged more.
Out-of-network: health care providers not contracted to provide services to customers on a particular health plan
Out-patient: a person who visits a hospital or clinic for medical services but does not require an overnight stay
Inpatient: a person who is admitted to a hospital for at least one night for ongoing care
Mental health care: the diagnosis and treatment of mental illnesses, such as depression
More Complete Lists of Health Insurance Terms
- eHealth Insurance, a licensed health insurance agency, offers a Health Insurance Glossary.
- HealthCare.gov has a glossary of insurance terms.
- Healthinsurance.org, an independent internet website, provides a Health Insurance Glossary.
Original post by the Center for Advancing Health. Updated by the GW Cancer Institute January 2016.