Health insurance terms you should be familiar with

Health insurance can be confusing, but understanding the most common terms can help make it easier to navigate. Here are 25 essential health insurance policy terms you should know:

  1. Premium: The monthly payment made for a health insurance policy.
  2. Deductible: The amount a person must pay out of pocket before their insurance kicks in.
  3. Co-pay: A fixed amount paid by a patient for a specific medical service.
  4. Co-insurance: The percentage split between a patient and their insurance company for medical expenses.
  5. Out-of-pocket maximum: The maximum amount a person must pay for medical expenses in a given year.
  6. In-network provider: A healthcare provider who has agreed to work with an insurance company for a negotiated rate.
  7. Out-of-network provider: A healthcare provider who does not have a contract with an insurance company.
  8. HMO (Health Maintenance Organization): A type of insurance plan that requires members to use in-network providers and have a primary care physician.
  9. PPO (Preferred Provider Organization): A type of insurance plan that allows members to use both in-network and out-of-network providers.
  10. EPO (Exclusive Provider Organization): A type of insurance plan that only covers services from in-network providers.
  11. Indemnity plan: A type of insurance plan that allows members to use any healthcare provider and reimburses them for covered services.
  12. Health savings account (HSA): A tax-advantaged savings account used to pay for medical expenses.
  13. Catastrophic coverage: A type of insurance plan that provides coverage for serious or life-threatening illnesses or injuries.
  14. Short-term insurance: A type of insurance plan that provides temporary coverage for a limited period of time.
  15. Universal coverage: A type of insurance plan that provides coverage for all residents of a given area, regardless of income or health status.
  16. Pre-existing condition: A medical condition that existed before the start of an insurance policy.
  17. Exclusion: A medical condition or service that is not covered by an insurance policy.
  18. Lifetime maximum: The maximum amount an insurance policy will pay for medical expenses over the policyholder’s lifetime.
  19. Out-of-pocket limit: The maximum amount a person must pay for medical expenses in a given year.
  20. Network: A list of healthcare providers who have contracted with an insurance company.
  21. Provider network: A list of healthcare providers who have contracted with an insurance company.
  22. Policyholder: The person who holds a health insurance policy.
  23. Insurance company: The entity that provides health insurance coverage.
  24. Coverage area: The geographic area in which an insurance plan provides coverage.
  25. Enrollment period: The period of time during which a person can sign up for a health insurance policy.

By familiarizing yourself with these terms, you can make informed decisions about your health insurance coverage and understand the policy you have chosen.