4Because our agency makes sure that you and your family have the right Health coverage, you don't necessarily have to know all the esoteric terms related to it. However, it makes sense to be a knowledgeable consumer. That's why we've compiled this list of key Health insurance-related definitions for you:
  • Balance billing. A bill for the difference between what your insurer will pay and what the physician charges for a service.
  • Coinsurance. The amount that you're required to pay for medical care in a fee-for-service plan after you've met your deductible. The co-insurance rate is usually expressed as a percentage. For example, if the insurance company pays 80% of the claim, you pay 20%.
  • Deductible. The amount of money you must pay each year to cover your medical care expenses before your insurance starts paying.
  • Exclusions. Specific conditions or circumstances for which the policy will not provide benefits.
  • Maximum out-of-pocket cost. The largest amount of money you will be required to pay a year for deductibles and coinsurance. It's a dollar amount set by the insurance company, in addition to regular premiums.
  • Preexisting condition. A health problem that existed before the date your insurance coverage became effective.
  • Primary care physician (PCP). A PCP monitors your health, diagnoses, treats minor health problems, and refers you to specialists if another level of care is needed. The PCP is often a family physician or internist; however, some women prefer to use their gynecologist.
  • Provider. Any person (doctor, nurse, dentist) or institution (hospital or clinic) that provides medical care.

The next time you come in for a visit (or discuss your Health coverage with your employer) you'll be able to show off your knowledge!

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Further Reading
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