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Insurance Terms and Definitions

  • Coinsurance: The percentage of each claim you must pay after your deductible is met.
  • Copayment: A predetermined amount you must pay for certain health care services.
  • Deductible: The amount you must pay before your health insurance benefits kick in.
  • Exclusions: Terms and/or conditions that are not covered by your health insurance plan.
  • Health Maintenance Organization (HMO): A health insurance plan that allows you to use the services of participating (in-network) physicians, hospitals and clinics.
  • Health Savings Account: A plan that allows you to contribute and use pre-tax money for qualified medical expenses. These accounts are portable and must be linked to a high-deductible health insurance plan.
  • High-Deductible Health Plan: A health insurance plan with lower premiums that covers health care expenses only after you meet your deductible (typically higher than traditional plans) each year.
  • Out-of-Pocket Maximum: A predetermined amount of money you must pay before your health insurance plan covers eligible costs at 100 percent.
  • Point-of-Service Plan (POS): A health insurance plan that allows you to choose between in-network and out-of-network care each time you need medical treatment.
  • Pre-Existing Condition: A coverage limitation on certain medical conditions for a specified period of time under a new policy. This can be a condition that is either previously diagnosed or that would require treatment prior to issue.
  • Preferred Provider Organization (PPO) Plan: Robust coverage with an expansive provider network. Allows you to go to your provider of choice without a referral.
  • Term Life Insurance: Life insurance that provides protection for a specified period of time.
  • Waiting Period: The time that must pass before you can collect insurance benefits.
  • Whole Life Insurance: Life insurance that is kept in force for a person’s whole life. It pays a benefit and also accumulates a cash value.