While you’re a pro when it comes to medical jargon, insurance terms may be a bit more convoluted. So, we’ve put together a cheat sheet of the insurance terms and phrases that are super important to know when deciding which benefits you’ll need.
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Deductible: The set dollar amount you must pay before your insurance coverage for medical expenses can begin. This means you’ll have to pay at least this much before insurance kicks in (except in certain cases such as preventative care!)

Coinsurance: The percentage of the charges you’re required to pay for a medical service after the deductible has been met. For example, the insurance carrier may pay 80% of the covered claim, and you’ll pay the remaining 20%.

Copayment / Copay: The flat fee you pay for a medical service, i.e. $20 for a doctor's visit or $20 for a prescription. Copays do not apply to the deductible.

Out-of-Pocket Maximum (OOP): The maximum amount you would have to pay in a plan year for eligible expenses. After you hit the Out-of-Pocket maximum, your insurance will then pay 100% of the allowable charges for covered services in network for the remainder of the plan year.

Network Provider: A hospital, doctor, medical group, nurse practitioner, and/or other healthcare provider contracted to provide services to insurance carrier’s customers for less than their usual fees.

Out of Network Provider: A hospital, doctor, medical group, nurse practitioner, and/or other healthcare providers who are not contracted to provide services to insurance carrier’s customers for less than their usual fees and contracted fees and can charge the member as much as they wish.

PPO: Preferred Provider Organization - a group of hospitals and healthcare providers that are contracted with insurance companies to provide medical services. Out of pocket costs are lower when a provider is used within the PPO network (called in-network).