Understanding Health Insurance Jargon

It can be very frustrating when you are trying to read and understand something, and yet constantly find yourself encountering terms with which you are unfamiliar. This will resonate with anyone who always finds themselves having to ask someone, or consulting the Internet to check the meaning of precise technical terms. Whether you are evaluating health insurance quotes in Jacksonville or other health insurance related documents, it is best to know the different jargon used in these documents so that you’ll be able to understand what’s being written and implied by the terms.

Understanding Health Insurance Jargon

The words used in terms and conditions can often cause a great deal of confusion. Here are some of the most common instances of health insurance jargon, and their respective meanings. Be sure to refer to this list the next time you shop for health insurance plans, and feel confident in your interpretation of each provider’s offer.

BENEFIT. Refers to the amount payable by the insurance provider for the medical expenses incurred by the insurance holder.

CLAIM. Refers to the request made by the insurance holder to the insurance provider for the payment of medical expenses.

CO-INSURANCE. The amount that the insurance holder has to pay for the cost of covered services after the deductible. The rate is determined by the percentage agreed upon by both parties. For instance, if the provider will pay 80% of the claim, the holder should pay for the 20%.

CO-PAYMENT. This is the fixed amount that the insurance holder has to pay for certain medical expenses. For instance, for every consultation, you have to pay for a flat rate of $10.

DEDUCTIBLE. This is the amount that the insurance holder needs to pay for medical care each year before the health insurance policy takes over the payments.

DEPENDENT. Refers to another individual or individuals covered by the primary holder’s health insurance plan. This person can be a spouse and/or a child/multiple children.

DRUG FORMULARY. Refers to the list of prescription drugs covered by the holder’s health plan.

EXCLUSION. Refers to any situation, condition, or treatment which will not be paid for and covered by the health insurance plan.

NETWORK. Refers to the doctors, clinics, hospitals, and other providers which the holder can consult at a discounted rate.

OUT OF POCKET MAXIMUM. This refers to the maximum amount of money that the holder will pay in a year. This may include deductibles, co-payments, co-insurance, and any fees aside from the regular premium.

PRE-EXISTING CONDITION. This refers to a health problem or illness that had already been diagnosed before the holder purchased a health insurance plan.

PREMIUM. The amount being paid by the holder for the health insurance coverage. It can be paid on a monthly, quarterly, or yearly basis depending on the agreement.

RIDER. Refers to add-ons that a holder can include in a basic insurance policy for an additional cost or premium.

Should you encounter any other terms and jargon that are not included in this list whilst you review prospective health insurance quotes, do not hesitate to get in touch with your chosen insurance provider. Ensure that you fully understand the terms before you enter into any agreement, most especially if that agreement concerns your health coverage.



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