Confused By Insurance Terms?
Confused by insurance terms? We've got you covered.
Related: Health Insurance Terms You Should Know - Part 2
Also Related: Health Insurance Terms-Part 3
Premium
Monthly bill you pay (or your employer pays for you) for insurance coverage.
Deductible
You pay this before your plan begins to pay for eligible charges from doctors and facilities.
Copay
An upfront fee you pay to a doctor for medical services. Depending on your plan, this may count toward your deductible.
Pharmacy or RX copay
Upfront fee for certain types of drugs.
Coinsurance
A percentage of charges that you pay a provider or facility after the deductible has been met (commonly 80/20 coverage).
Total member responsibility
After your insurance carrier has paid their portion of a bill (if applicable), you’re left with this amount. It includes copays, coinsurance, and the deductible.
Out-of-pocket maximum
The maximum amount you will pay toward your deductible, coinsurance, and copays. If you meet the out-of-pocket maximum, eligible services are covered 100% for the rest of the year.
