While you're a pro at medical jargon, insurance terms can feel a little more complicated. We've put together a quick cheat sheet of key insurance terms to help you confidently choose the benefits that best meet your needs:
Deductible
The set dollar amount you must pay out of pocket before your insurance coverage begins for most medical expenses. (Preventive care is often covered before you meet your deductible!)
Coinsurance
The percentage of costs you’re responsible for after you've met your deductible. For example, your insurance might cover 80% of a claim, and you would pay the remaining 20%.
Copayment / Copay
A flat fee you pay for specific services — for example, $20 for a doctor's visit or $20 for a prescription. Copays typically do not count toward your deductible.
Out-of-Pocket Maximum (OOP)
The maximum amount you’ll pay for covered services in a plan year. Once you reach your out-of-pocket maximum, your insurance will pay 100% of eligible in-network costs for the rest of the year.
Network Provider
A doctor, hospital, or healthcare provider who has contracted with your insurance company to offer services at discounted rates.
Out-of-Network Provider
A doctor, hospital, or healthcare provider not contracted with your insurance company. They can charge you more than the insurance plan’s allowed rates, resulting in higher out-of-pocket costs.
PPO (Preferred Provider Organization)
A type of health plan that offers a network of doctors and hospitals. You’ll pay less if you use providers within the PPO network (in-network), but you can still see out-of-network providers at a higher cost.