Insurance Terms
The amount the member pays every month for their insurance
What is Premium?
A flat fee the member pays each time the member visits a doctor
What is Copay?
The amount the member pays for medical services before their insurance starts to pay
What is Deductible?
A percentage the member pays for doctor visits once their deductible has been met
What is Coinsurance?
Maximum the member pays for everything except their monthly premium during a plan year
What is out of pocket limit?
A group of health care providers who have agreed to special negotiated rates from the insurance company
What is Network?
A List of medications covered by the health plan
What is Formulary?
A federal health insurance program for low-income families and children, eligibile pregnant women, people with disabilities, and other adults
What is Medicaid?
A federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with end-stage renal disease
What is Medicare?
A kind of health insurance plan where members usually must get services through doctors, labs, and hospitals that contract or work with the HMO
What is health maintenance organization?