The maximum amount an insurance plan has agreed to pay for a particular medical service. If an out-of-network provider charges more than the allowed amount, you may have to pay the difference.

Balance billing occurs when a healthcare provider bills a patient for the difference between the provider’s charge for a service and the allowed amount covered by the patient’s insurance plan. Balance billing only occurs when the individuals go to an Out-of-Network provider.

A beneficiary is a person or entity designated to receive benefits or assets from an insurance policy, retirement account, trust, will, or other financial instrument upon the death of the policyholder or account holder. Beneficiaries can be individuals, such as family members or friends, or organizations, such as charities or non-profit organizations. It is essential to keep beneficiary designations up to date to ensure that assets are distributed according to the account holder’s wishes.

Formal request by a policyholder to an insurance company for coverage or compensation for a loss or damage that is covered under the terms of the insurance policy.

Your share of the cost of a covered medical service calculated as a percent of the allowed amount for the service. The medical plan pays the rest of the allowed amount. You are responsible for the coinsurance until you reach your plan’s out-of-pocket maximum.

A fixed amount, which you pay at the time of service. For specific medical services, you may have a copay, a specific charge required by your insurance company for certain medical, dental, or vision visits. While copays do not usually count toward the deductible, they do count toward your out-of-pocket maximum. Copays are most common for prescription drugs, office visits, urgent care, and emergency room visits.

The amount you must pay out-of-pocket for eligible expenses before the health plan begins to pay benefits. Your plan will not pay anything for certain medical services until you have met your deductible amount. The deductible may not apply to all services, for example, services that are covered by a copay.

A family member, such as a spouse, child, or domestic partner, who is covered under the primary policyholder’s insurance plan. Dependents are entitled to the same insurance benefits as the policyholder, including coverage for medical expenses, prescriptions, and other healthcare services.

The date on which the insurance coverage begins.

The process of signing up for and officially becoming a member of an insurance plan or policy.

A specified period of time after the due date for a premium payment during which the policy remains in effect without penalty.

An in-network provider is a healthcare professional or facility that has contracted with a specific insurance company to provide services at pre-negotiated rates to insured individuals (A discounted rate).

An insured is a person or organization whose life, health, or property is covered by an insurance policy.

The insurance company that provides coverage to the participant (or the insured individual).

The highest amount your insurer will pay for a claim that your insurance policy covers.

The highest amount of money that can be borrowed against life insurance policies, 401k’s, etc.

The person to whom coverage has been extended by the policyholder (such as their employer) or any of their covered family members.

An out-of-network provider does not have a service contract with your health insurance company or health plan. Your out-of-pocket costs may increase, and services may be subject to balanced billing.

The most you pay during the plan year before your plan begins to pay 100% of the allowed amount. This limit does not include your premium or balance-billed charges.

Employees and our beneficiaries: the spouse and kids.

The individual who carries the insurance plan.

A premium in insurance is the amount of money an individual or entity pays to an insurance company in exchange for coverage under an insurance policy (Weekly/Bi-weekly rate).

Americans with Disabilities Act

Accidental Death and Dismemberment

Consolidated Omnibus Budget Reconciliation Act

Employee Assistance Program

Explanation of Benefits. Issued by insurance companies to participants to explain what amount of their medical expenses was covered.

Evidence of Insurability. Sometimes called evidence of good health, often required by insurers before issuing an LTD or GTL policy.

Group Term Life Insurance

High Deductible Health Plan

Health Savings Account

Long Term Disability

Preferred Provider Organization

Summary Plan Description

Short Term Disability