Understanding Health Insurance Terms

Deductible - You pay a certain amount each year, out of your own pocket, before the plan starts to pay for your care

Copayment - Small amount you pay each time you obtain treatment

Managed Care Plans – Somprehensive health services with financial incentives for patients to use the providers who belong to the plan.

• Health maintenance organizations (HMOs),
• Preferred provider organizations (PPOs),
• Exclusive provider organizations (EPOs), and
• Point of service plans (POSs).

Premium – Fees paid for coverage of medical benefits for a defined benefit period. Some premiums are paid by employers, employees, unions, or share by both the insured and the plan sponsor.

Primary Care Physician (PCP) – Physician who serves as primary contact within the health plan; in a managed care plan, the primary care physician provides basic medical services, coordinates and, if required by the plan, authorizes referrals to specialists and hospitals.