We know health care can be confusing, so we've included some common terminology below with quick and easy to understand definitions.
Frequently Used Medical Insurance Terminology
Copay
A fixed amount (for example, $25) you pay for a covered health care service, usually at the time of service.
Coinsurance
Your share of the costs of a covered health care service, calculated as a percent (for example, 20%) of the allowed amount for the service. You pay coinsurance plus any deductibles you owe.
Deductible
The amount you owe for eligible health care services before your insurance begins to pay. In-network preventive care is always covered at 100% and is not subject to your annual deductible.
Network
The amount you owe for eligible health care services before your insurance begins to pay. In-network preventive care is always covered at 100% and is not subject to your annual deductible.
Out-of-Pocket Maximum
The most you could pay during a a calendar year for your share of the costs of covered services. After you meet this limit, the plan will pay 100 percent of the allowed amount.
This limit helps you plan for health care costs. This limit never includes your premium, balance-billed charges or health care your health insurance or plan doesn't cover.
Premium or Per Paycheck Contribution
The amount you pay for your health insurance each pay period.