Common Health Insurance Terms


It is open enrollment now for many group health insurance plans and many of us are busy weighing our options and trying to determine the best health insurance coverage to meet our needs. However, in order to understand the different choices, it is necessary to be familiar with certain health insurance terms including the following:

A fixed dollar amount that you are expected to pay for a covered service, usually at the time that the service is delivered.
Your share of the cost of a covered service, calculated as a percent of the allowed amount of the service.
The amount you must pay for covered health care services before your health insurance plan begins to pay for a part of covered services.
Excluded Services
Medical services that your health insurance plan does not cover.
A group of health care providers, facilities and suppliers that your insurance plan has contracted with to provide health care services. If you receive care from a provider that is not within your plan’s network, your out-of-pocket cost may be higher.
Out-of-Pocket Limit
The most you pay during a specific plan period before your health insurance plan begins to pay 100% of the allowed amount.
The amount that must be paid to your health insurance provider for your coverage. This amount may be paid monthly, quarterly or annually.

While these terms are helpful in gaining a better general understanding of how health insurance works, please note that every plan is different and some may use different terms or interpret them differently. Therefore, if you have specific questions about your policy or potential policy, it is best to contact the health insurance provider directly for clarification.

Posted on behalf of Dr. Carlos Alarcon, Marietta OB-GYN Affiliates, P.A.