Insurance List & Self-Pay Options

Health Insurance Glossary

1. Beneficiary: An individual who receives the benefits from an insurance policy if the policyholder dies or becomes unable to receive those benefits.

2. Co-pay: A fixed amount of money that a policyholder pays out of pocket for a specific healthcare service, usually at the time of service.

3. Coinsurance: The percentage of the cost of covered healthcare services that a policyholder is responsible for paying after the deductible has been met.

4. Cost Sharing: The collective amount that policyholders are responsible for paying towards their healthcare costs, which may include co-pays, coinsurance, and deductibles.

5. Deductible: The amount of money a policyholder must pay out of pocket for healthcare services before their insurance coverage kicks in.

6. Employer-Sponsored Coverage: A type of health insurance plan provided by an employer to its employees as part of their benefits package.

7. Formulary: A list of prescription drugs that an insurance plan covers and typically categorizes them based on their cost.

8. Gold Health Plan: A type of health insurance plan with a high premium but lower out-of-pocket costs.

9. Health Coverage: Insurance that covers the cost of medical and surgical expenses incurred by the policyholder.

10. Health Insurance: A type of insurance coverage that pays for medical and surgical expenses incurred by the policyholder.

11. HMO: HMO stands for Health Maintenance Organization, which is a type of health insurance plan that requires policyholders to choose healthcare providers from a specific network.

12. In-network: Refers to healthcare providers who are contracted with an insurance plan and have agreed to provide healthcare services to policyholders at a negotiated rate.

13. Individual Health Insurance Policy: A type of health insurance plan that is purchased by an individual rather than provided by an employer.

14. Medicaid: A government-funded program that provides healthcare coverage to low-income individuals and families.

15. Medicare: A government-funded program that provides healthcare coverage to individuals over the age of 65, as well as those with certain disabilities and medical conditions.

16. Open Enrollment Period: A specified period of time during which individuals can enroll in or make changes to their health insurance plan.

17. Out-of-network: Refers to healthcare providers who are not contracted with an insurance plan and therefore may charge policyholders higher rates for healthcare services.

18. Out-of-pocket: The amount of money that a policyholder is responsible for paying toward their healthcare expenses.

19. Policy Year: The period during which an insurance policy is in effect, typically one year from the date of purchase.

20. PPO: PPO stands for Preferred Provider Organization, which is a type of health insurance plan that allows policyholders to see both in-network and out-of-network healthcare providers.

21. Premium Tax Credit: A tax credit provided to individuals to help lower the cost of their health insurance premiums.

22. Recipient Identification Number (RIN): A unique identifier assigned to individuals who are enrolled in government-funded healthcare programs such as Medicaid.

23. Silver Health Plan: A type of health insurance plan with moderate premium and out-of-pocket costs.

24. Subsidized Coverage: A type of health insurance coverage that is partially or fully paid for by the government or another organization.