Glossary of Health Coverage and Medical Terms
||Your share of the costs of a covered health care service, calculated as a percent (for example, 20%) of the allowed amount for service. You pay co-insurance plus any deductibles you owe. For example, if the health insurance or plan’s allowed amount for an office visit is $100 and you’ve met your deductible, your co-insurance payment of 20% would be $20. The health insurance or plan pays the rest of the allowed amount.
||A fixed amount (for example, $15) 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.
||The amount you owe for health care services your health insurance or plan covers before your health insurance or plan begins to pay. For example, if your deductible is $1,000, your plan won’t pay anything until you’ve met your $1,000 deductible for covered health care services subject to the deductible. The deductible may not apply to all services.
||The facilities, providers and supplies your health insurer or plan has contracted with to provide health care services.
||The most you pay during a policy period (usually a year) before your health insurance or plan begins to pay 100% of the allowed amount. This limit never includes your premium, balance-billed charges or health care your health insurance or plan doesn’t cover. Some health insurance or plans don’t count all your co-payments, deductibles, co-insurance payments, out-of-network payments of other expenses toward this limit.
||The amount that must be paid for your health insurance or plan. You and/or your employer usually pay it monthly, quarterly or yearly.
*Source: Glossary of Health Coverage and Medical Terms