Insurance terms can be confusing. It can seem like a foreign language. We've been doing this a long time and speak this language!
Let's start with the basics:
What is a premium?
The dollar amount you pay for a insurance policy.
What is a deductible?
The dollar amount you have to pay before the insurance company pays for a covered service. Some services do not have a deductible.
What is coinsurance?
When you pay a percentage of a service and the insurance company pays a portion.
What is max out-of-pocket?
The total dollar amount you responsible to pay, usually includes deductibles, coinsurance and copays.
What is a co-pay?
The dollar amount you have to pay for a doctors visit, prescription, or service.
What is a network?
A list of doctors, hospitals, and pharmacies contracted to provide care and services.
What is a PPO, Preferred Provider Organization?
A type of health plan that contracts with medical providers, such as hospitals and doctors, to create a network of participating providers. You pay less if you use providers that belong to the plan's network.
What is a HMO, Health Maintenance Organization?
A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally won't cover out-of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage.
What is a EPO, Exclusive Provider Organization?
A managed care plan where services are covered only if you go to doctors, specialists, or hospitals in the plan's network (except in an emergency).
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