Health Insurance Glossary of Terms

The annual period during which members may enroll or change their current plan.

In the individual market, this runs from Nov 1 – Dec 15 for January 1st effective dates.

Groups may define their own, but it is typically tied to the renewal date.

The amount you must pay for medical care after you have met your deductible. Typically, your plan will pay 80 percent of an approved amount, and your coinsurance will be 20 percent, but this may vary from plan to plan.

The flat fee you pay each time you receive medical care. For example, you may pay $10 each time you visit the doctor. Your plan pays the rest.

The amount you must pay each year before your plan begins paying.

Pays benefits if you are injured or become seriously ill and are no longer able to work.

Services that are not covered by a plan. Sometimes called limitations. These exclusions and limitations must be clearly spelled out in plan literature.

Traditional (indemnity) health insurance where you and your plan each pay a portion of your health expenses, usually after you meet a yearly deductible. In most cases, you can choose any physician, hospital, or other provider (non-network based coverage).

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