The words that show up on every plan document, defined the way you would explain them to a friend.
- Premium
- The fixed amount paid every month to keep coverage in force, whether or not you use it.
- Deductible
- The amount you pay out of pocket for covered services each year before the plan starts paying its share.
- Copay
- A flat dollar amount you pay for a specific service, like $30 for an office visit.
- Coinsurance
- Your percentage share of a covered cost after the deductible is met — 20% coinsurance means the plan pays 80%.
- Out-of-pocket maximum
- The most you can be required to pay for covered in-network care in a plan year; after that the plan pays 100%.
- Network
- The doctors, hospitals and facilities that have agreed to contracted rates with your plan — using them costs far less.
- Guaranteed issue
- Coverage you cannot be turned down for based on health, with no medical questions or exam at initial enrollment.
- Voluntary benefits
- Coverage offered through your employer but paid by you, usually through payroll deduction at group rates.
- Hospital indemnity
- A plan that pays you a set cash amount when you are admitted to a hospital, regardless of what the hospital bills.
- Critical illness
- A plan that pays a lump sum in cash upon diagnosis of a covered condition such as cancer, heart attack or stroke.
- Short-term disability
- Coverage that replaces part of your income for weeks or months when illness, injury or childbirth keeps you from working.
- MEC (Minimum Essential Coverage)
- A plan design that satisfies the Affordable Care Act's baseline requirement, covering preventive services in full.
- HSA (Health Savings Account)
- A tax-advantaged account, available with qualifying high-deductible plans, used to pay medical costs with pre-tax dollars.
- HealthShare
- A membership arrangement in which participants share eligible medical costs — lower cost than insurance, but not insurance.
- Open enrollment
- The annual window when you can join, change or drop coverage without needing a qualifying life event.
- Qualifying life event
- A change such as marriage, birth, a move or loss of coverage that opens a special window to enroll outside open enrollment.