Health Insurance Glossary

Stethoscope on books 590x390 Health Insurance Glossary Photo

Shopping for health insurance can be confusing, to say the least, and with all that health plan jargon it can feel like reading another language. Make your search a bit easier this year, and use this handy Health Insurance Glossary while maneuvering your way through the benefits of each plan.

Co-insurance- noun \ˌkō-ən-ˈshu̇r-ən(t)s also -ˈin-ˌ\ The cost-sharing agreement between you and your insurance company, in which you pay a set percentage of the covered costs (after the deductible and copayment have been met), and your health insurance company pays the rest

Co-pay- noun \ˈkō-ˈpāA fixed amount you pay for a covered health care service, usually when you get the service; the payment can vary per type of provider (specialist co-pays tend to be higher), but is always a specific dollar amount

Deductible- noun \di-ˈdək-tə-bəl, dē-\ The amount of money you have to pay before your insurance starts to cover any benefits

EHR- noun \i-ˌlek-ˈträ-nik-ˈhelth-ri-ˈkȯrd\ Electronic Health Record: Your official health record that is shared among multiple facilities and agencies that are updated in real time

EPO- noun \iks-ˈklü-siv-prə-ˈvī-dər-ˌȯr-gə-nə-ˈzā-shən\ Exclusive Provider Organization: A form of health care in which you must receive your care from affiliated providers and you are generally not covered for out-of-network care; unlike with HMOs, with an EPO, you may not need a referral from your primary care physician

Formulary- noun \ˈfȯr-myə-ˌler-ēA list of prescription drugs that are covered by a specific health care plan

FSA- noun \ˈflek-sə-bəl-ˈspendiŋ-ə-ˈkau̇nt\ Flexible Spending Account: An employer-sponsored benefit that enables employees to set aside pre-tax dollars out of their paycheck to pay for eligible health care expenses

HDHP- noun\ˈhī-di-ˈdək-tə-bəl-ˈhelth-ˈplan\ High Deductible Health Plan: A form of health care in which you usually pay lower premiums and higher deductibles than in traditional health plans; HDHP’s are usually combined with HSAs (Health Savings Accounts) so you can pay out-of-pocket expenses with pre-tax money

HMO- noun \ˈhelth-ˈmānt-nən(t)s-ˌȯrg-(ə-)nə-ˈzā-shən\Health Maintenance Organization: A form of health care in which you may only visit in-network providers on the plan’s list except in an emergency; most often, you will need to consult your primary care physician before seeing any specialists

Out-of-network- noun \ˈau̇t-əv-ˈnet-ˌwərk\ Doctors, hospitals or other health care providers that your insurance company has not contracted with to provide care; the amount you have to pay of your service bill will vary depending on the type of insurance plan you have

Out-of-pocket Maximum- noun \ˈau̇t-əv-pä-kət-ˈmak-s(ə-)məm\ The most you will have to pay during a policy period for the health care services you receive before your insurance plan will start to pay for 100% of your medical expenses; deductibles, co-pays and co-insurance count toward your out-of-pocket maximum

PHO- noun \fə-ˈzi-shən-ˈhäs-(ˌ)pi-təl-ˌȯr-gə-nə-ˈzā-shən\ Physician-Hospital Organization: An alliance between physicians and hospitals to help health care service providers attain market share, improve bargaining power and reduce administrative costs; these entities sell their services to managed care organizations or directly to employers

POS- noun \ˈpȯint-əv-ˈsər-vəs\ Point of Service Plan: A form of health care that allows you to seek care from a physician affiliated with the service provider at a fixed co-payment or to choose a nonaffiliated physician and pay more; it’s kind of a blend of an HMO plan with a PPO plan

PPO- noun \prə-ˌfərd-prə-ˈvīd-ər-\ Preferred Provider Organization: A type of health insurance arrangement that allows you relative freedom to choose the doctors and hospitals you want to visit, in-network or out-of-network; you do not need a referral from your primary care physician to see a specialist

Premium- noun \ˈprē-mē-əm\ The lump sum you pay your health insurance company at the beginning of each calendar year; your premium does not count toward your deductible