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A set amount that is charged and paid at the time of service for certain types of medical services.
What is Copay?
A percentage that insurance indicates the patient is responsible for, meaning the patient and the insurance company will share the cost of service.
What is Coinsurance?
An annual amount the patient is responsible for under their health plan before the health plan will begin to pay for services.
What is annual deductible?
Providers/hospitals that contract with the Payor and agree to accept a discounted rate for services provided.
What is In Network?
Providers/hospitals that are not contracted with the Payor.
What is Out of Network (OON)?
The person in whose name the insurance is issued.
What is subscriber?
A set of benefits offered by an insurance company.
What is plan?
An insurance company
What is Payor?
A person covered under an insurance plan.
What is a member?
The portion of medical expenses the patient is responsible for paying when they receive medical care.
What is Out of Pocket (OOP)?
An annual amount that is the highest or total amount the health plan will require to pay towards the cost of their healthcare.
What is annual OOP maximum?