Glossary

Copay:  The specific cost to the insured for a specific service. Deductible normally does not apply.

Deductible: The set dollar amount that a person must pay before coinsurance begins to apply. Usually resets on a calendar year cycle.

HMO/EPO:  Health Maintenance Organization. A limited or narrow network of doctors and hospitals that offer a higher discount level due to agreements with insurance carriers.

HSA:  A savings account that uses pre-tax (payroll deductions) or post-tax dollars (outside funding) to pay for healthcare services. Money placed in this account cannot be spent on anything but healthcare expenses (medical, dental, vision, etc.).

In vs. Out-of-Network:  In-Network refers to doctors, hospitals, and healthcare providers who are contracted with an insurance carrier to provide services to its members. Out-of-network providers are those who are not contracted with your insurance provider and generally do not offer discounts towards services.

Out-of-Pocket Maximum:  The total amount paid by a member for all copays, deductibles, and coinsurance. After reaching the out-of-pocket maximum, the plan will pay 100% and the member will not be responsible for further charges on covered services. Usually resets on a calendar year cycle.

PPO:  Preferred Provider Organization. Is considered a ‘normal’ network of doctors and hospitals that offer a discount on services with insurance.

Preventive Care:  Services that are intended to prevent future illness or injury. Usually include annual physicals, immunizations, etc.

Urgent Care vs. Emergency Care:  Urgent care clinics are intended to act as one-time Primary Care Offices where you can get a prescription or receive a quick examination. Emergency rooms and ER pop-ups, while similar to urgent care facilities, are meant to act as locations for life-threatening emergency services. Please ensure that if you visit an urgent care or an emergency room, that you are attending the right one. The copays and coinsurance will drastically differ.

Usual & Customary Charges:  Amount paid for a medical service in a geographic area based on what providers in the area usually charge for the same or similar medical service.