Health Insurance Glossary: Terms and Definitions

Health Insurance Definitions You Should Know

 

Knowing common health insurance terms and their definitions can help you understand coverage options and support healthcare choices that are right for you and your family.

Insurance Terms And Definitions From A-Z

 

Get to know health insurance definitions from A-Z.

A-C    D-E    F-H    I-L    M-O    P-R    S-Z

 

 

A-C Health Insurance Terms

 

Accident Insurance

Accident insurance provides cash benefits for medical and recovery expenses, regardless of any other insurance you have. Benefits are paid after health insurance cost adjustments or discounts negotiated with your doctors have been applied. Learn more about accident insurance.

 

Affordable Care Act (ACA)

The Affordable Care Act (ACA) helps ensure all Americans have access to affordable health insurance. It offers financial help based on your income, to help reduce your healthcare costs.

 

If you qualify for a subsidy, you can select from health insurance plans on the Health Insurance Marketplace that fit your budget.

 

Coinsurance

Coinsurance is the percentage of costs you pay after you meet your health plan deductible. Your coinsurance percentage will vary depending on the health insurance plan you choose.

 

Copay

The fixed dollar amount you pay to a healthcare provider at the time you receive services. You may have a copay for each covered visit to your doctor, depending on your plan. Copays generally do not apply toward the deductible.

 

Critical Illness Insurance

Critical illness insurance provides a cash payout on covered critical illnesses. It can be used to satisfy your health plan deductible, as well as cover living expenses and additional out-of-pocket costs like prescriptions or other treatments.

 

D-E Health Insurance Terms

 

Deductible

A fixed dollar amount during the coverage period — usually a year — that you pay before your insurer starts to make payments for covered medical services.  

 

Emergency Services

A medical screening of a patient’s condition by a hospital emergency department. Emergency services also include any further medical examination and treatment required to stabilize the patient. The ACA considers emergency services an essential health benefit and requires insurance plans to cover them.

 

Exclusive Provider Organization (EPO)

An EPO is a hybrid of an HMO and a PPO. EPOs generally offer a little more flexibility than an HMO and are usually less expensive than a PPO. EPOs allow members to see specialists without a referral from their primary care doctor. 

 

F-H Health Insurance Terms

 

Health Maintenance Organization (HMO)

HMOs offer coverage from select in-network doctors and hospitals and sometimes require a referral from your primary care provider (PCP) to see a specialist. An HMO will not cover out-of-network providers, unless it is an emergency. The HMO in-network model helps keep healthcare costs low for members.

 

Health Savings Account (HSA)

An HSA lets you save money for future medical costs. When you put money in the account, it is not subject to federal income tax. Funds can also be saved over time and are not required to be spent in a single year. 

 

Hospital Indemnity Insurance

Hospital indemnity insurance lets you extend your protection. Benefits can be used to help with financial setbacks such as lost wages, the cost for help with rehabilitative services, medical deductibles, and even copays.

 

I-L Health Insurance Terms

 

In-Network

Any doctor or hospital that is contracted with your health insurance plan. 

 

Inpatient Care

Inpatient care is care provided in a hospital or other type of inpatient facility where you are admitted and spend at least 24 hours, depending on your condition.

 

Limited Duration Insurance

Limited duration insurance is a type of short term health insurance that provides coverage to members for a period of as little as a month to as long as three years. The plans offer coverage for services similar to ACA plans, and are an option for those who don’t qualify for financial help on a Marketplace health plan. 

 

M-O Health Insurance Terms

 

Out-of-Network Provider

A healthcare provider who is not part of a plan’s network. Costs associated with out-of-network providers may be higher or not covered by your plan.

 

Out-of-Pocket Costs

These are costs you have to pay including coinsurance, copays, and deductibles. Out-of-pocket costs vary by plan and each plan has a maximum out-of-pocket cost.

 

Outpatient Care

Healthcare services that do not need an overnight stay in a hospital. These services are often provided in a doctor’s office, hospital, or clinic.

 

P-R Health Insurance Terms

 

Preferred Provider Organization (PPO)

A PPO is a health plan with a “preferred” network of providers in your area and does not require a primary care provider (PCP) referral to see a specialist.  A PPO health plan generally has a higher monthly premium and provides coverage for out-of-network services. 

 

Premium

Your monthly payment for a health insurance plan.

 

Primary Care Physician (PCP)

A doctor who directly provides or coordinates a range of healthcare services for a patient. A PCP may be required for some health coverage like HMOs.

 

S-Z Health Insurance Terms

 

Specialist

A doctor that offers specialized medical care not provided by your primary care physician (PCP). Some health insurance coverage like HMOs may require a referral from your PCP to see a specialist.

 

Supplemental Insurance

An additional insurance plan that helps pay for healthcare costs that are not covered by your existing health insurance plan. Supplemental insurance plans may include accident insurance, critical illness insurance, or hospital indemnity insurance. 

 

Urgent Care

Care for an illness, injury, or condition serious enough that requires a person to seek care right away, but not so severe or life-threatening as to require immediate emergency care.

 

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