Kaiser Family Foundation Health Reform questions:

KFF Health Reform FAQ’s

Ohio Department of Insurance Federal Health Reform questions:

ODI Federal Health Reform FAQ’s

Ohio Department of Insurance Affordable Care Act Glossary of Terms:

ODI Glossary of Terms

Ohio Department of Insurance Ohio Medicare Beneficiaries questions:

FAQs Ohio Medicare Beneficiaries

Ohio Health Benefits Medicare questions:

Medicare Ask an Expert


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.