Health Insurance Terms
Defined below, in order to help you understand health insurance more fully, are some health insurance terms that you may see on your policy or hear from your insurance provider.
Benefits
Amount that the insured will receive from his insurance company after filing a claim.
Claim
An individual’s request to the insurance company to receive payment for a health care professional.
Co‐Insurance
The money that is required from an individual for services, after the deductible is paid. Normally specified in percentages.
Deductible
How much is owed by an individual before the insurance will cover the costs; based on an annual amount.
Disability Insurance
Long-term or short-term coverage that pays you if you cannot work for an large period of time due to injury or a condition.
Group Health Insurance
Coverage that is provided via an employer or other organization that covers all members of the group.
Health Savings Account
A high‐deductible plan that is paired with an individual’s personal savings account, which is utilized to accrue finances for medical expenses that qualify.
High‐Deductible Health Plan
Also known as catastrophic healthcare, a plan with high‐costs to the insured individual that can cover medical expenses that exceed a typical limits of a basic healthcare plan.
Indemnity Health Plan
Also know as a reimbursement plan, it lets you pick you physician and covers expenses partly, completely, or up to an agreed amount for a certain period of time.
Individual Health Insurance
Insurance that covers you on an individual basis and normally comes with high premiums.
Long‐Term Care Policy
Covers specified services for a certain span of time that may include nursing care, custodial care, and health care services in your home.
Major Medical Insurance
Covers you in the event of a loss from catastrophic injury or illness and allows for very high benefits.
Managed Care
Attempts to manage the cost and quality of an individual’s health insurance. Most offer HMOs and PPOs that those individuals are encouraged to use for their services.
Network
A group of health care providers that have been contracted to provide medical care for less than their normal pay.
Pre‐existing Condition
A medical condition that the insured had before applying for insurance; certain restrictions apply.
Premium
The cost of an individual’s health insurance, paid by the individual.
Provider
A hospital or a facility with a team of healthcare professionals that provide health care
services.
