Let’s face it. Health insurance can be confusing. To help simplify things, we’ve compiled the most important resources in one place—from connecting with our Insurance Specialists, to checking benefits online, to understanding the most commonly used terms. It’s our way of giving you the tools you need to find the answers you want.
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Connect with one of our Insurance Specialists to get answers right over the phone. You may receive a comprehensive summary of benefits, including out-of-pocket costs. Plus, see if you qualify for additional savings and support with appeals.
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Commonly Used Insurance Terms
Can’t tell your co-pay from your deductible?
That’s okay. We’ve compiled the most commonly used and often misunderstood insurance terms and explain them in a straightforward, easy-to-understand way.
For a more comprehensive guide on health insurance, download our health insurance brochure.
Health Insurance: Understanding the basics
The maximum amount your health insurance will pay for the year. You’re required to pay all costs after you reach the annual limit.
A process that confirms your benefits and eligibility or your insurance coverage for a prescription or medical service.
This is a percentage of a prescription or medical service that you pay after meeting your deductible.
A fixed amount you pay for a doctor’s visit, prescription, or other medical service.
This card is used to lower your insurance co-pay, or out-of-pocket costs, for a prescription medication.
Insurance you can get from your job or buy directly from insurance companies.
The amount you pay for health care services before your insurance starts paying.
A statement from your insurance administrator that details what charges are eligible for benefits under your plan.
You can choose to see any doctor, but you pay more.
The list of medicines that your health insurance plan will pay for or cover.
Insurance programs paid for and operated by the federal and state governments.
The health care items or services covered under a health insurance plan.
This service, run by the federal government, allows you to search for affordable government and private health care plans. Some states offer a marketplace specifically for their residents.
Your doctor, pharmacy, and health care services are within the same network.
A state government insurance plan that offers health care coverage and drug benefits to low-income individuals.
A federal government insurance plan that provides health care coverage options and prescription benefits for people over 65 years old, or younger people with disabilities.
An annual period during which people can enroll in a group-sponsored health insurance plan for the next year.
The most you’ll pay in medical expenses in a year before you’re fully covered.
Covers prescription drugs that are usually self-administered, such as oral, injectable, or in other ways taken outside the physician’s office.
A third-party administrator, contracted by the insurance plan, to manage prescription drug coverage/programs for their insured population.
An insurance plan that requires you to choose a primary care physician. You can choose a preferred provider or one outside of your network. For out-of-network providers, you will need a referral and will most likely pay more.
You choose from a list of preferred providers. If you choose providers outside the network, you may pay more.
Health insurance that helps pay for your medication.
Your health care provider must provide additional information to your insurance company before they’ll cover a service or medication.
A pharmacy that distributes medications with special storage and handling requirements, as well as other complexities.
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