Helpful Terms to Know

 

Co-payment (co-pay) - The amount you pay to a healthcare provider at the time you receive services. You may have to pay a copay for each covered visit to your doctor, depending on your plan. 

Covered person - Any person covered under the plan.

Deductible - The amount you pay for your healthcare services before your health insurer pays.  Deductibles are based on your benefit period (typically a year at a time).  

Ex:  If your plan has a $2000 annual deductible, you will be expected to pay the first $2000 toward your healthcare services. After you reach $2000, your health insurer will cover the rest of the costs

HMO (Health Maintenance Organization) - Offers healthcare services only with specific HMO providers.  Under an HMO Plan, you might have to choose a primary care doctor.  This doctor will refer you to other HMO specialists when needed.  Services from providers outside the HMO plan are hardly ever covered except for emergencies. 

Non-covered charges - Charges for services and supplies that are NOT covered under the health plan.  

Non-network Provider/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.  Consult your plan for more information. 

Out-of-pocket cost - Cost you must pay. Out-of-pocket costs vary by plan and each plan has a maximum out of pocket (MOOP) cost. Consult your plan for your information. 

PPO (Preferred Provider Organization) - A type of insurance plan that offers more extensive coverage for the services of healthcare providers who are part of the plan's network, but still offers some coverage for providers who are not part of the plan's network.  PPO plans generally offer more flexibility than HMO plans, but premiums tend to be higher. 

Premium - Payments you make to your insurance provider to keep your coverage.  The payments are due at certain times.