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Insurance terms

To truly understand your coverage, you need to have a grasp of terms related to health insurance.

Benefits: the medical services for which your plan pays.
Co-payment (co-pay): the fixed amount you pay for every medical service, independent of any deductible.
Co-insurance: the fixed amount or percentage you pay after paying the deductible. For example, if your insurance plan pays 80 percent of your medical expenses after you meet a $250 annual deductible, you are responsible for the remaining 20 percent.
Deductible: the amount you pay each year or each cycle before your plan pays.
Inpatient care: hospital care with an overnight stay.
Out-of-pocket expense: the total amount you pay for all services, including co-payments, deductibles, co-insurance and premiums.
Outpatient care: any service without an overnight hospital stay.
Premium: your regular payment for your insurance to your insurer.
Preferred providers: a list of doctors and hospitals that accept a discounted fee from a preferred provider organization (PPO).
Primary care physician: a general physician who provides care, makes referrals and arranges for tests or hospitalization.

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