Glossary

Premium

The amount you pay for your health coverage, typically each month. It's sometimes referred to as your monthly payment.

Deductible

This is the dollar amount you must pay out-of-pocket for healthcare services before your plan kicks in.

Example: My plan has a deductible of $1,500. If I haven't yet paid $1,500 towards my deductible, I must continue paying out of my pocket until I do. It's good to know which things apply toward my deductible, and which ones don't.

Out-of-Pocket Max

Also known as "OOP maximum" or "out-of-pocket maximum". This is the most you would pay during the coverage time (typically a year) before your eligible costs are paid 100%. Keep in mind that this does not include premiums, which you have to pay each month.

Coinsurance

Usually represented as a percentage, this reflects the costs of a covered healthcare service that you're responsible for after you've met your deductible, but before you've met your out-of-pocket max.

Copay

A fixed amount (for example, $15) a plan requires you to pay for a covered healthcare service. This payment is typically due when you receive a service or fill a prescription.

In Network

Health plans connect with certain providers and/or healthcare facilities to provide lower rates than out-of-network providers.

Example: I am changing my health coverage—it's important that I check to see if my preferred doctor is considered in-network with my new health insurance company; otherwise it may cost me more to see that doctor.

Health Savings Account

A tax-advantaged account created for individuals who are covered under high-deductible health plans (HDHPs) to save for medical expenses that HDHPs do not cover. Contributions are made into the account by the individual or the individual's employer and are limited to a maximum amount each year.