Kaiser Family Foundation Health Reform questions:
Ohio Department of Insurance Federal Health Reform questions:
Ohio Department of Insurance Affordable Care Act Glossary of Terms:
Ohio Department of Insurance Ohio Medicare Beneficiaries questions:
Ohio Health Benefits Medicare questions:
Health Care Definitions
Note: These definitions are provided only to give you a general understanding of how these words are sometimes used by health insurance companies.
Benefit – A service or supply that is covered under a health insurance plan. This might include office visits, lab tests, and procedures during the course of treatment.
Coinsurance – Your share of the costs of a covered health care service, calculated as a percent (for example 20%) of the eligible expense for the service. You pay coinsurance after you pay your deductible.
Coinsurance out-of-pocket maximum – The most coinsurance you pay during a calendar year before your insurance begins to pay 100% of the eligible expenses. This limit never includes: premiums, deductibles, copayments, out-of-network payments or services your health insurance does not cover.
Copay/Copayment – A fixed amount (for example $35) you pay for a covered health care service, usually when you receive the service. The amount can vary by the type of covered health care service.
Deductible – The amount of money you owe for covered health care services before your health insurance or plan begins to pay.
Eligible Expenses – Maximum amount on which payment is based for covered health care services. This may also be called “allowed amount,” “payment allowance,” or “negotiated rate”.
Emergency Services – Evaluation of an emergency medical condition and treatment to keep the condition from getting worse.
Excluded Services – Health care services that your health insurance doesn’t pay for or cover.
Limitation – The most – in terms of costs and services – a health plan will cover.
Network – The facilities, providers, and suppliers your health insurer of plan has contracted with to provide health care services.
Network Provider – A provider who has a contract with your health plan’s network to provide services to you at a discount. This may also be called “preferred provider”.
Out-of-Network Provider – A provider who doesn’t have a contract with your health plan’s network. You’ll pay more to see an out-of-network provider for non-emergency services. This may also be called a “non-preferred provider” or “non-network provider”.
Premium – The amount that must be paid for your health insurance. You usually pay it monthly or quarterly.
Prescription/RX Drugs – Drugs and medications that by law require a prescription.