Common Health Insurance Terms

We understand that navigating the insurance maze can be daunting. Insurance companies use terms like, “Copay” and “Out of Pocket” and sometimes their terms can seem like a foreign language. Here are some of the most common terms you may hear and what they mean.

Insurance Premium– This is the cost of your plan, the monthly bill you, or your employer, pays for insurance coverage.

Deductible-This is the amount you pay BEFORE your insurance plan kicks and pays for certain services.

Copay– This is the upfront fee you pay to your doctor for services and office visits. This also applies to some medications.

Coinsurance– This is the amount you pay for services after your deductible has been met.

Total Member Responsibility-The amount that you owe for services AFTER your insurance plan has paid their portion. This can include deductibles, copays and coinsurance.

Out of Pocket Maximum– This the MOST you will be required to pay towards your deductible, copays and coinsurance. When you meet the Out of Pocket Maximum, all eligible charges for medical services are covered at 100% for the rest of the year.

Have questions? Give us a call!